Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Shock. 2024 Mar 1;61(3):387-394. doi: 10.1097/SHK.0000000000002243. Epub 2023 Oct 6.
Background: Sepsis is caused by the invasion of the bloodstream by microorganisms from local sites of infection, leading to high mortality. This study aimed to compare the predictive ability of the biomarkers presepsin, procalcitonin (PCT), and C-reactive protein for bacteraemia. Methods: In this retrospective, multicentre study, a dataset of patients with sepsis who were prospectively enrolled between November 2017 and June 2021 was analyzed. The performances of the biomarkers for predicting positive blood cultures and infection with specific pathogens were assessed by the areas under the receiver operating characteristic curves (AUCs). The independent effects of the pathogen and foci of infection on presepsin and PCT levels were assessed by linear logistic regression models. Results: A total of 577 patients with 170 positive blood cultures (29.5%) were enrolled. The AUC achieved using PCT levels (0.856) was significantly higher than that achieved using presepsin (0.786, P = 0.0200) and C-reactive protein (0.550, P < 0.0001) levels in predicting bacteraemia. The combined analysis of PCT and presepsin levels led to a significantly higher AUC than the analysis of PCT levels alone for predicting blood culture positivity (0.877 vs. 0.856, P = 0.0344) and gram-negative bacteraemia (0.900 vs. 0.875, P = 0.0216). In a linear regression model, the elevated concentrations of presepsin and PCT were both independently related to Escherichia coli , Klebsiella species, Pseudomonas species, and Streptococcus species infections and Sequential Organ Failure Assessment score. Presepsin levels were also associated with Acinetobacter species and abdominal infection, and PCT levels were positively associated with other Enterobacteriaceae and negatively associated with respiratory infection. Combined analysis of presepsin and PCT levels provided a high sensitivity and specificity in identifying E. coli or Klebsiella species infection. Conclusions: Presepsin and PCT were promising markers for predicting bacteraemia and common pathogens at the time of sepsis onset with a synergistic effect.
败血症是由局部感染部位的微生物侵入血流引起的，死亡率很高。本研究旨在比较降钙素原（PCT）、C 反应蛋白和前降钙素（presepsin）这三种生物标志物对菌血症的预测能力。
本回顾性多中心研究分析了 2017 年 11 月至 2021 年 6 月期间前瞻性纳入的败血症患者的数据集。通过受试者工作特征曲线（ROC）下面积（AUC）评估生物标志物预测阳性血培养和感染特定病原体的性能。采用线性逻辑回归模型评估病原体和感染灶对降钙素原和前降钙素水平的独立影响。
共纳入 577 例患者，其中 170 例血培养阳性（29.5%）。与 C 反应蛋白（0.550，P < 0.0001）相比，PCT 水平预测菌血症的 AUC 显著更高（0.856，P = 0.0200），与 presepsin（0.786，P = 0.0200）相比，PCT 水平预测菌血症的 AUC 显著更高。PCT 和 presepsin 联合分析预测血培养阳性的 AUC 显著高于单独分析 PCT 水平（0.877 比 0.856，P = 0.0344）和革兰氏阴性菌血症（0.900 比 0.875，P = 0.0216）。线性回归模型显示，前降钙素和 PCT 浓度升高均与大肠埃希菌、克雷伯菌属、铜绿假单胞菌和链球菌属感染以及序贯器官衰竭评估评分独立相关。前降钙素水平还与不动杆菌属和腹部感染有关，而 PCT 水平与其他肠杆菌科呈正相关，与呼吸道感染呈负相关。PCT 和 presepsin 联合分析在确定大肠埃希菌或克雷伯菌属感染方面具有较高的敏感性和特异性。
在败血症发病时，前降钙素和 PCT 是预测菌血症和常见病原体的有前途的标志物，具有协同作用。
