Presepsin区分脓毒症患者G-菌与G+菌、真菌感染的价值

The value of serum presepsin in differentiating Gram-negative bacteria from Gram-positive bacteria and fungal infection in sepsis patients

目的验证可溶性白细胞分化抗原14亚型(presepsin)能否用于区分脓毒症患者革兰氏阴性菌(G-菌)感染与革兰氏阳性菌(G+)、真菌感染。方法采用前瞻性研究方法,收集于2017年6月至2018年11月重症监护病房(ICUs)细菌或真菌培养阳性的脓毒症患者,根据培养结果分为G-菌组、G+菌组和真菌组。入院时取外周血检测presepsin和降钙素素原(PCT)水平。结果(1)共156例患者纳入研究,96例(62%)患者G-菌感染,25例(16%)患者G+菌感染,35例(22%)患者真菌感染;(2)G-菌组presepsin水平明显高于G+菌组(P = 0.005)和真菌组(P = 0.000);(3)ROC曲线下面积(AUC)比较,presepsin区分G-菌感染与G+菌、真菌感染明显优于PCT(AUC: 0.809 vs 0.712,P = 0.024),presepsin联合PCT后区分G-菌感染与G+菌、真菌感染明显优于单独presepsin(AUC: 0.866 vs 0.809,P = 0.041)。结论与PCT相比,presepsin可更好地用于区分脓毒症患者G-菌与G+菌、真菌感染。

Objective To examine whether presepsin level can serve as a distinguishing marker between G- bacteria and G+ bacteria, fungal infection in sepsis patients. Methods A prospective observation study was conducted on the consecutive patients with positive bacterial cultures in intensive care unit (ICU) from June 2017 to November 2018. The patients were divided into the G- group, G+ group and fungal group. Blood samples were collected upon admission to measure the levels of presepsin and procalcitonin (PCT). Results (1) Of the 156 patients met the inclusion criteria. 96 (62% G- rods, 25 (16%) G+ microbes, and 35 (22%) fungi were detected.(2) Presepsin concentrations were significantly higher in the G- group compared with the G+ and fungal groups (P = 0.000).(3) Presepsin level has a higher accuracy in differentiating G- sepsis from Gram+ and fungal sepsis than PCT level [area under the curve (AUC): 0.809 vs 0.712]. The AUC value of a combination of presepsin and PCT level was significantly larger than that of presepsin level alone in differentiating G- sepsis from Gram+ and fungal sepsis (AUC: 0.866 vs 0.809). Conclusions In contrast to PCT, presepsin is a good discriminative biomarker in different infections.