降钙素原作为一家三级医院重症监护病房疑似脓毒症入院的重症患者细菌感染的生物标志物。
Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital.
作者信息
Bibi Afshan, Basharat Nida, Aamir Muhammad, Haroon Zujaja Hina
机构信息
Afshan Bibi (FCPS Chemical Pathology), Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan.
Nida Basharat (FCPS Chemical Pathology), Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan.
出版信息
Pak J Med Sci. 2021 Nov-Dec;37(7):1999-2003. doi: 10.12669/pjms.37.7.4183.
OBJECTIVE
To compare the diagnostic accuracy of procalcitonin (PCT), C- reactive protein (CRP), total leukocyte count (TLC) and lactate in critically ill patients admitted with suspicion of sepsis.
METHODS
It was a cross sectional study conducted at the department of Chemical Pathology and Endocrinology AFIP, Rawalpindi, in collaboration with Medical and surgical intensive care units (ICU) of CMH Rawalpindi from January 2019 to December 2019. A total of 126 patients of both genders with age above 18 years and fulfilling the inclusion criteria of systemic inflammatory response syndrome (SIRS) were inducted in the study.
RESULTS
Out of 126 patients 82 (65%) patients have positive blood culture results. Male predominance was noted in patients with positive blood culture. Out of 82 patients with positive blood culture results 69(84%) patients have positive PCT results as well whereas 13(15%) patients with positive blood culture results have negative PCT values. 57(69%) patients had Gram negative bacterial infection and 25(30%) patients had Gram positive bacterial infection. Significant difference was noted between the medians of PCT in blood culture positive and blood culture negative group (p value< 0.05) whereas no significant difference was found between medians of CRP, TLC and lactate between blood culture positive and blood culture negative patients (p value > 0.05). ROC curve analysis of PCT, CRP and TLC were done, keeping blood culture as reference standard, PCT showed largest area under the curve (AUC) and clearly outperformed TLC and CRP. PCT showed AUC of 0.781 as compared to CRP and TLC, which was 0.568 and 0.617 respectively. PCT showed sensitivity of 93.9%, specificity of 47.7%, positive predictive value (PPV) of 77% and negative predictive value (NPV) of 80.8%.
CONCLUSION
Higher NPV makes it a reliable marker for screening out sepsis in suspected cases.
目的
比较降钙素原（PCT）、C反应蛋白（CRP）、白细胞总数（TLC）和乳酸对疑似脓毒症重症患者的诊断准确性。
方法
这是一项横断面研究，于2019年1月至2019年12月在拉瓦尔品第武装部队病理研究所化学病理学和内分泌科与拉瓦尔品第CMH医院的内科和外科重症监护病房（ICU）合作开展。共有126例年龄在18岁以上且符合全身炎症反应综合征（SIRS）纳入标准的男女患者纳入研究。
结果
126例患者中，82例（65%）血培养结果为阳性。血培养阳性患者中男性居多。82例血培养结果阳性的患者中，69例（84%）PCT结果也为阳性，而13例（15%）血培养结果阳性的患者PCT值为阴性。57例（69%）患者为革兰阴性菌感染，25例（30%）患者为革兰阳性菌感染。血培养阳性组和血培养阴性组的PCT中位数之间存在显著差异（p值<0.05），而血培养阳性患者和血培养阴性患者的CRP、TLC和乳酸中位数之间未发现显著差异（p值>0.05）。以血培养为参考标准，对PCT、CRP和TLC进行ROC曲线分析，PCT曲线下面积（AUC）最大，明显优于TLC和CRP。PCT的AUC为0.781，而CRP和TLC的AUC分别为0.568和0.617。PCT的敏感性为93.9%，特异性为47.7%，阳性预测值（PPV）为77%，阴性预测值（NPV）为80.8%。
结论
较高的NPV使其成为筛查疑似病例中脓毒症的可靠标志物。
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