连续降钙素原监测能否预测脓毒症患儿的临床结局？一项诊断管理研究。
Does serial procalcitonin monitoring predict clinical outcomes in children with sepsis? A diagnostic stewardship study.
作者信息
Rubbab Beenish, Davila Samuel, Moreland Jessica, Firmani Sarah, Most Zachary
机构信息
Division of Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
出版信息
Antimicrob Steward Healthc Epidemiol. 2025 Jun 3;5(1):e124. doi: 10.1017/ash.2025.10032. eCollection 2025.
OBJECTIVE
To determine if the initial procalcitonin level and the serial trend of procalcitonin levels in blood were predictive of clinical outcomes in children with sepsis.
DESIGN
A retrospective cohort study.
SETTING
One primary-to-quaternary care pediatric healthcare system from May 2020 to May 2022.
PARTICIPANTS
Encounters for children 1 to 18 years old with a sepsis ICD-10 diagnosis code and clinical sepsis were included.
METHODS
Procalcitonin clearance at 48 hours (CL-PCT) was defined as the difference in procalcitonin values drawn on admission and at 48 hours divided by initial procalcitonin value. The primary outcome was early clinical stability. Receiver operating characteristic analysis was performed to measure the correlation of CL-PCT and initial procalcitonin value (PCT) with the outcomes.
RESULTS
320 unique encounters met the clinical criteria of sepsis with at least two procalcitonin values. 187 encounters had procalcitonin collected at eligible times. The mean age of the participants was 9 years and 8 months, 103 (55%) were male, and 74 (40%) were Hispanic. 78 (41.7%) individuals had good early clinical response, and 177 (94.7%) survived. There was no correlation identified between CL--PCT and early clinical stability (area under ROC curve [AUC] = 0.57, 95% CI 0.48-0.65) or mortality (AUC = 0.60, 95% CI 0.43-0.76). There was also no correlation between PCT and early clinical stability (AUC = 0.47, 95% CI 0.39-0.56) or mortality (AUC = 0.50, 95% CI 0.29-0.72).
CONCLUSION
Procalcitonin clearance at 48 hours after admission did not predict early clinical stability in children with sepsis.
目的
确定脓毒症患儿血液中降钙素原初始水平及降钙素原水平的连续变化趋势是否可预测临床结局。
设计
一项回顾性队列研究。
设置
2020年5月至2022年5月期间的一个从一级到四级护理的儿科医疗保健系统。
参与者
纳入年龄在1至18岁、有脓毒症ICD - 10诊断代码且临床诊断为脓毒症的患儿。
方法
48小时降钙素原清除率（CL - PCT）定义为入院时及48小时时所测降钙素原值的差值除以初始降钙素原值。主要结局为早期临床稳定。进行受试者操作特征分析以测量CL - PCT和初始降钙素原值（PCT）与结局的相关性。
结果
320例符合脓毒症临床标准且至少有两个降钙素原值的病例。187例病例在合适时间采集了降钙素原。参与者的平均年龄为9岁8个月，103例（55%）为男性，74例（40%）为西班牙裔。78例（41.7%）个体有良好的早期临床反应，177例（94.7%）存活。未发现CL - PCT与早期临床稳定（ROC曲线下面积[AUC] = 0.57，95%CI 0.48 - 0.65）或死亡率（AUC = 0.60，9%CI 0.43 - 0.76）之间存在相关性。PCT与早期临床稳定（AUC = 0.47，95%CI 0.39 - 0.56）或死亡率（AUC = 0.50，95%CI 0.29 - 0.72）之间也无相关性。
结论
入院后48小时的降钙素原清除率不能预测脓毒症患儿的早期临床稳定。
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