降钙素原在社区获得性发热疾病患者中菌血症预测价值

Procalcitonin in prediction of bacteremia in patients with community acquired fever

目的 探讨降钙素原(PCT)在社区获得性发热疾病患者中菌血症预测价值。方法 回顾性收集2015年1月至2016年1月本院急诊部门拟发热待查因而入院的成人患者,记录患者基本资料以及入院时白细胞计数(WBC)、中性粒细胞百分比(NEU%)、PCT、血培养等结果,运用受试者工作特性曲线(ROC曲线)评价各炎症指标对菌血症的预测价值。结果 在研究期间,共纳入发热性疾病患者223例,引起发热最常见的病因是呼吸道感染(54.7%),病毒感染次之(11.7%);78.0%(174/223)患者送检了血培养,其中菌血症组(n=13)与非菌血症组(n=161),菌血症组PCT水平显著高于非菌血症组(P<0.01),而WBC、NEU%差异无统计学意义(均P>0.01)。经ROC曲线分析,PCT(AUC=0.793,95%CI 0.631~0.955)诊断菌血症价值最高,明显高于WBC(AUC=0.691,95%CI 0.510~0.872)、NEU%(AUC=0.620,95%CI 0.391~0.849),P<0.001,而WBC与NEU%曲线下面积差异无统计学意义(P>0.01)。当PCT<0.45 ng/ml,基本排除菌血症(NPV=95.5%)。结论 急诊部门拟发热待查因而入院成人患者中,呼吸道感染是最常见的病因。相比WBC、NEU%,PCT在排除菌血症方面显示出更好的价值,而且PCT检测时间短<1 h,一方面可以减少血培养数量,另一方面可以为临床提供快速诊断,指导早期经验用药。

Objective To explore the value of procalcitonin(PCT)in predicting bacteremia in patients with community acquired fever.Methods The adult patients with fever who visited our emergency department and were hospitalized were retrospectively enrolled from January,2015 to January,2016;the basic data,white cell count(WBC),neutrophil percentage(NEU%),PCT,and blood culture results were recorded.The area under the ROC curve(AUC)was constructed to evaluate the discriminative power of variables to predict bacteremia.Results During the study,a total of 223 patients were enrolled.Of these patients,respiratory tract infection(54.7%)was the most common fever cause,and virus infection(11.7%)came next.Blood culture were obtained from 78.0%(174/223)patients,including bacteremia(n=13)and non-bacteremia(n=161);the PCT level was significantly higher in the bacteremia group than in the non-bacteremia group(P<0.01),while there were no statistical differences in WBC and NEU%between the two groups(P>0.01).The area under the receiver operating characteristic curve was 0.793,and 95%CI 0.793-0.631 for PCT,which was significantly higher than that for WBC(AUC=0.691,95%CI 0.510-0.872)and NEU%(0.620,95%CI 0.391-0.849).While the area under the curve of the WBC and NEU%had no statistical difference(P>0.01).When the PCT was less than 0.45 ng/ml,bacteremia can be excluded,with a negative predictive value of 95.5%.Conclusions At our emergency department,respiratory infection is the most common fever cause.PCT concentration is more useful in predicting bacteremia than WBC and NEU%.Also,the determination time of PCT is less than 1 h,which may be effectively used to exclude bacteremia and establish early antibiotic treatment plans.