血清降钙素原和感染可能性评分对危重症患者感染预测的比较研究

Comparative study of procalcitonin serum level and infection probability score for the diagnosis of severe infection in ICU patients

目的比较血清降钙素原(PCT)和感染可能性评分(IPS)在评估危重症患者感染中的价值。方法对不明原因全身炎症反应综合征(SIRS)和(或)伴有休克的患者,观察其出现SIRS首个24h的临床相关感染指标和PCT值。以血清PCT≥0.5ng/mL和IPS>14分别为评估感染的阈值,根据最终临床感染诊断比较IPS和PCT值在预测感染中的价值。结果47例患者入选,血清PCT检测感染的敏感性70.7%,特异性83.3%,其阳性预测值96.7%,阴性预测值29.4%,阳性似然比4.24。IPS检测感染的敏感性75.6%,特异性66.7%,阳性预测值93.9%,阴性预测值28.6%,阳性似然比2.27。结论血清PCT是评价感染较好的生化指标,其预测感染价值特别是特异性优于IPS。

Objective To evaluate the performance of procalcitonin (PCT) and infection probability score (IPS) as the marker of infection in critically ill patients.Methods Patients: Critically ill patients with SIRS and/or uncertain shock. Measurements: The serum PCT and IPS were determined within 24 hours after clinical onset of SIRS , the clinical status and biomarkers were also recorded. At cut-off values of PCT≥0.5 ng/mL and IPS>14, we compared the value of PCT and IPS in diagnosing the infection.Results 47 patients were enrolled. Compared with IPS, the serum PCT level had lower sensitivity (70.7% versus 75.6%), an ideal specificity (83.3% versus 66.7%), similar positive predictive value(96.7% versus 93.9 %) and negative predictive value (29.4% versus 28.6%). The positive likelihood ratio of PCT was better than IPS(4.24 versus 2.27). Conclusions In the present study PCT was found to be a more accurate diagnostic parameter for differentiating infectious SIRS and non-infectious SIRS better than IPS.