Cho Hyunseok, Lee Jung Ho, Park Sung Chul, Lee Sung Joon, Youk Hee-Jeong, Nam Seung-Joo, Park Jin Myung, Kim Tae Suk, Kim Ji Hyun, Kim San Ha, Lee Sang Hoon
Department of Pediatrics, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon 24289, Republic of Korea.
Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon 24289, Republic of Korea.
J Clin Med. 2025 Mar 21;14(7):2135. doi: 10.3390/jcm14072135.
Bacterial and viral gastroenteritis present with overlapping symptoms, including vomiting, diarrhea, and abdominal pain. Stool tests have been used to differentiate between them; however, stool cultures are time-consuming and stool polymerase chain reaction (PCR) tests are expensive. The role of the clinical value of procalcitonin (PCT) and C-reactive protein (CRP) as diagnostic markers of bacterial gastroenteritis remains to be investigated. This study evaluated the diagnostic value of PCT for the early diagnosis of bacterial gastroenteritis. The medical records of patients diagnosed with gastroenteritis by the emergency department with positive stool PCR results confirming the diagnosis between 1 January 2020 and 31 July 2024 were retrospectively reviewed. Demographic characteristics and laboratory findings, including PCT and CRP levels, were analyzed. The area under the curve (AUC) for the diagnosis of bacterial gastroenteritis was assessed to determine the diagnostic potential of PCT and CRP. Among the 1882 cases identified, 1435 met the inclusion criteria. CRP exhibited a sensitivity of 79.0% and specificity of 78.6% (AUC: 0.848, 95% CI: 0.815-0.881) in diagnosing bacterial gastroenteritis. In comparison, PCT showed lower sensitivity (60.3%) and specificity (62.6%) (AUC: 0.660, 95% CI: 0.614-0.706). However, in patients aged >17 years with fever (≥38 °C), PCT demonstrated an improved AUC of 0.767 (95% CI: 0.603-0.932; = 0.019). : CRP demonstrated moderate sensitivity in predicting bacterial gastroenteritis; however, its false-negative rate suggests limitations in clinical decision-making. While PCT may assist clinicians in identifying bacterial gastroenteritis in febrile adult patients, its diagnostic accuracy remains suboptimal, necessitating further validation through larger studies.
细菌性和病毒性肠胃炎的症状有重叠，包括呕吐、腹泻和腹痛。粪便检测曾被用于区分这两种疾病；然而，粪便培养耗时，粪便聚合酶链反应（PCR）检测费用高昂。降钙素原（PCT）和C反应蛋白（CRP）作为细菌性肠胃炎诊断标志物的临床价值仍有待研究。本研究评估了PCT对细菌性肠胃炎早期诊断的价值。回顾性分析了2020年1月1日至2024年7月31日期间急诊科诊断为肠胃炎且粪便PCR结果呈阳性确诊的患者的病历。分析了人口统计学特征和实验室检查结果，包括PCT和CRP水平。评估了诊断细菌性肠胃炎的曲线下面积（AUC），以确定PCT和CRP的诊断潜力。在确定的1882例病例中，1435例符合纳入标准。CRP在诊断细菌性肠胃炎时的敏感性为79.0%，特异性为78.6%（AUC：0.848，95%CI：0.815 - 0.881）。相比之下，PCT的敏感性（60.3%）和特异性（62.6%）较低（AUC：0.660，95%CI：0.614 - 0.706）。然而，在年龄>17岁且发热（≥38°C）的患者中，PCT的AUC提高到了0.767（95%CI：0.603 - 0.932；P = 0.019）。CRP在预测细菌性肠胃炎方面表现出中等敏感性；然而，其假阴性率表明在临床决策中存在局限性。虽然PCT可能有助于临床医生识别发热成年患者中的细菌性肠胃炎，但其诊断准确性仍不理想，需要通过更大规模的研究进行进一步验证。
