Department of Internal Medicine, University of Louisville, Louisville, KY, USA.
Department of Hematology & Oncology, University of Louisville, Louisville, KY, USA.
Expert Rev Hematol. 2022 Jun;15(6):559-564. doi: 10.1080/17474086.2022.2079490. Epub 2022 May 23.
Patients with sickle cell disease (SCD) are at increased risks of infection. Fever often occurs with vaso-occlusive crisis (VOC), posing a diagnostic challenge in SCD. Procalcitonin (PCT) is an infectious biomarker validated in the general population but with limited data on use in SCD.
We performed a retrospective single-center study (n = 145) with primary objective of assessing ability of PCT to differentiate infection from VOC in SCD presenting with fever. Subgroups included confirmed bacterial infection (CBI), suspected bacterial infection, viral infection, and VOC. A secondary objective examined the association of PCT with acute chest syndrome. Clinical characteristics and data were collected and analyzed to assess the diagnostic performance of PCT and associated variables.
Of the cohort, 16% had CBI and 8% had viral infection. PCT was able to discriminate CBI from viral infection [AUC = 0.89 (95%CI, 0.78-0.99)] and VOC [AUC = 0.87 (95%CI, 0.78-0.97)]. PCT had an association with ACS but poor diagnostic performance [AUC = 0.69 (95% CI, 0.54-0.84)].
PCT has utility in distinguishing confirmed bacterial infection from VOC or viral infection and is a promising biomarker when investigating fever in SCD.
镰状细胞病（SCD）患者感染风险增加。发热常伴有血管阻塞性危象（VOC），这给 SCD 的诊断带来了挑战。降钙素原（PCT）是一种在普通人群中得到验证的感染生物标志物，但在 SCD 中的应用数据有限。
我们进行了一项回顾性单中心研究（n=145），主要目的是评估 PCT 在 SCD 发热患者中区分感染与 VOC 的能力。亚组包括确诊细菌感染（CBI）、疑似细菌感染、病毒感染和 VOC。次要目标是研究 PCT 与急性胸部综合征的相关性。收集并分析临床特征和数据，以评估 PCT 及相关变量的诊断性能。
队列中有 16%的患者存在 CBI，8%的患者存在病毒感染。PCT 能够区分 CBI 与病毒感染（AUC=0.89 [95%CI，0.78-0.99]）和 VOC（AUC=0.87 [95%CI，0.78-0.97]）。PCT 与 ACS 相关，但诊断性能不佳（AUC=0.69 [95% CI，0.54-0.84]）。
PCT 在鉴别确诊细菌感染与 VOC 或病毒感染方面具有一定的应用价值，是 SCD 发热患者中一种有前途的生物标志物。
