降钙素原判断血流感染患者细菌类型及预后的价值

Serum procalcitonin levels on determining bacterial types and prognostic value in blood stream infection

目的:评估降钙素原在判断细菌性血流感染患者细菌类型及预后中的价值。方法:回顾性分析2016年我院血培养阳性住院患者274例,选择血培养阴性患者92例作为对照组,收集患者基础资料,比较血培养采集当日的降钙素原(PCT)、C反应蛋白(CRP)、白细胞(WBC)、中性粒细胞(Neut)及其百分比(Neut%)分别在细菌性血流感染组和对照组、革兰阴性菌血流感染组(GNB-BSI)和革兰阳性菌血流感染组(GPB-BSI)、存活组和死亡组中有无差异。结果:GNB-BSI组PCT、WBC、Neut的值均高于GPB-BSI组(P<0.05);GPB-BSI组PCT、WBC、Neut、Neut%的值均高于对照组(P<0.05)。细菌性血流感染中PCT-AUC为0.835,Neut-AUC为0.770,CRP-AUC仅为0.687,但PCT、CRP、Neut三者联合的AUC(曲线下面积)高达0.862。死亡组患者的PCT、Neut、Neut%、WBC水平均高于存活组。ROC曲线显示PCT预测患者28d预后的意义,与CRP、Neut相当。结论:PCT水平对早期判断细菌性血流感染和血流感染细菌类型有一定的参考价值,但预测细菌性血流感染预后的意义不大。

Objective:To evaluate the value of procalcitonin(PCT)in determining bacterial types and prognosis in patients with bloodstream infection.Methods:A total of 274 patients with positive blood culture and 92 patients with negative blood culture(control group)were included in China-Japan Friendship Hospital from January to December 2016 by retrospective analysis.The common clinical data were summarized from all the patients.The laboratory results of all the patients were collected on the day of blood culture,such as PCT,Creactive protein(CRP),white blood cell(WBC),neutrophil(Neut),percentage of neutrophils(Neut%).The data were compared between different groups,such as the bloodstream infection(BI)group and control(C)group,Gram negative bacterial bloodstream infection(GNB-BSI)group and Gram positive bacteria bloodstream infection(GPB-BSI)group,the survival(S)group and death(D)group.Results:PCT,WBC,Neut of GNB-BSI group were higher than those of GPB-BSI group(P<0.05).PCT,WBC,Neut,Neut%of GPB-BSI group were higher than those of control group(P<0.05).In all bacterial bloodstream infection,PCT-AUC was 0.835,Neut-AUC was0.770,and the CRP-AUC was only 0.687,but the combined AUC of PCT,CRP and Neut%was as high as0.862.The PCT,Neut,Neut%and WBC levels in the D group were higher than those in the S group,but the ROC curve showed that PCT and Neut could predict a 28-day prognosis with weak significance.Conclusion:PCT level have certain reference value for early diagnosis of bloodstream infection and the type of bloodstream infection,but the prognosis of bloodstream infection is weak.