Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia.
Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia.
Anaesthesiol Intensive Ther. 2023;55(5):319-325. doi: 10.5114/ait.2023.134214.
Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients.
A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days.
Patients with gram(-) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(-) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692-0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541-0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(-) BC. Age and high serum CRP levels were significant predictors of poor outcomes.
PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.
大手术后的患者发生脓毒症的风险很高，脓毒症伴有 C 反应蛋白（CRP）和降钙素原（PCT）的血清水平升高。本研究旨在探讨外科患者脓毒症病因相关的血清生物标志物水平的差异。
这是一项回顾性研究，在外科重症监护病房（ICU）进行，纳入了 2019 年 1 月至 2022 年 5 月期间因阳性血培养（BC）而入院的 81 例脓毒症患者。记录阳性 BC 当天及随后 3 天内 PCT、CRP、白细胞（WBC）和血小板计数的血清水平。
革兰氏阴性脓毒症患者的 PCT 水平显著升高，血小板计数显著降低，与革兰氏阳性脓毒症患者相比。所有测量中 PCT 升高和血小板计数降低均是革兰氏阴性分离株的显著预测因子，在 BC 采样后第 3 天的 AUC 值最高，为 0.821（95%CI：0.692-0.950），P=0.001，以及 AUC 值为 0.676（95%CI：0.541-0.811），P=0.02。在多变量逻辑回归中，BC 采样后第 1 天的血小板和第 3 天的 PCT 对区分革兰氏阳性和革兰氏阴性 BC 有显著贡献。年龄和高血清 CRP 水平是不良结局的显著预测因子。
PCT 和血小板计数可能是预测外科患者脓毒症病因的有用生物标志物。
