Ozger Hasan Selcuk, Senol Esin
Infectious Disease and Clinical Microbiology, Gazi University School of Medicine, Ankara, Turkey.
Turk J Emerg Med. 2022 Sep 30;22(4):169-176. doi: 10.4103/2452-2473.357347. eCollection 2022 Oct-Dec.
The use of infection biomarkers in the emergency department is discussed in terms of their possible contributions to diagnostic-prognostic uncertainties, appropriate antibiotic treatments, and triage and follow-up planning. Procalcitonin (PCT), C-reactive protein (CRP), proadrenomedullin (proADM), and presepsin are among the most discussed infection biomarkers for use in the emergency department. Due to the variable sensitivity results and cutoff values, there are insufficient data to recommend the widespread use of CRP and procalcitonin (PCT) for the diagnosis and prognosis of infection in the emergency department. However, these biomarkers can be used for appropriate antibiotic use in selected infection groups, such as community-acquired pneumonia, especially to reduce unnecessary antibiotic prescribing. With its prognostic superiority over other biomarkers and its contribution to prognostic score systems in community-acquired pneumonia (CAP), proADM can be used to predict hospitalization, preferably within the scope of clinical studies. Although presepsin has been shown to have some advantages over other biomarkers to rule out sepsis, there are insufficient data for its clinical use in the emergency department.
本文讨论了感染生物标志物在急诊科的应用，包括其对诊断-预后不确定性、适当抗生素治疗以及分诊和随访计划的可能贡献。降钙素原（PCT）、C反应蛋白（CRP）、肾上腺髓质素原（proADM）和可溶性髓系细胞触发受体-1（presepsin）是急诊科讨论最多的用于感染诊断的生物标志物。由于敏感性结果和临界值存在差异，目前尚无足够数据推荐在急诊科广泛使用CRP和降钙素原（PCT）进行感染的诊断和预后评估。然而，这些生物标志物可用于特定感染人群的抗生素合理使用，如社区获得性肺炎，特别是减少不必要的抗生素处方。肾上腺髓质素原（proADM）在社区获得性肺炎（CAP）中具有优于其他生物标志物的预后价值，并对预后评分系统有贡献，可用于预测住院情况，最好在临床研究范围内。虽然可溶性髓系细胞触发受体-1（presepsin）已显示出在排除脓毒症方面优于其他生物标志物，但在急诊科临床应用的数据不足。
