血浆降钙素原在脓毒症早期的诊断价值

目的 评价血浆降钙素原(PCT)在脓毒症早期的诊断价值.方法 分别对24例脓毒症及27例非脓毒症全身炎症反应综合征( SIRS)患者的PCT动态监测,比较两组PCT水平.结果 入院8小时内两组患者PCT水平无显著性差异(P＞0.05),24小时后,脓毒症组PCT水平明显高于非脓毒症SIRS组(P＜0.05).以PCT值2μg/L为临界值,诊断早期脓毒症的敏感性为75％,特异性为85.2％,准确性为80.4％.结论 PCT可以作为脓毒症早期诊断的指标之一,具有良好的敏感性、特异性及准确性.     

前降钙素在烧伤患者并发脓毒症预测中的应用

目的 动态监测血浆前降钙素(PCT)对烧伤并发脓毒症患者预测的价值.方法 将72例烧伤患者按是否并发脓毒症分为两组;选择同期烧伤科收治的32例烧伤二期行瘢痕松解或改型的患者为对照组.患者于入院后2、4、6、8、10、16、20 d,对照组于人院后2d收集血标本.采用双抗体夹心免疫发光法(ILMA)测定血浆PCT水平,用酶联免疫吸附法(ELISA)测定血浆C-反应蛋白(CRP)水平.结果 未并发脓毒症的烧伤患者血浆PCT水平较对照组轻度升高,CRP一直维持在较高水平;脓毒症烧伤患者PCT、CRP明显高于对照组(均P＜0.05).脓毒症组血浆PCT较非脓毒症组明显升高(均P＜0.05),而CRP差异无统计学意义(均P＞0.05).分别以PCT 2.2μg/L、CRP 250 mg/L作为预测感染的临界值,结果 PCT的敏感性98％、特异性94％、阳性预测值88％,均明显高于CRP(85％、82％、68％).而且脓毒症组患者的住院时间(d)较非脓毒症组明显延长(44.2±5.0比26.8±4.0,P＜0.05).结论 血浆PCT是预测烧伤患者并发脓毒症的敏感指标,进行常规PCT检测有助于早期发现创伤后感染并发症,并能预测创伤患者的转归和预后.     

血浆PCT及NGAL水平对多发伤并脓毒症的预测价值

目的探讨血浆中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase associated lipocalin,NGAL)及血浆降钙素原(Procalcitonin,PCT)的含量及其对多发伤并脓毒症的预测价值。方法回顾性分析2013年1月—2015年1月收治的符合纳入标准的多发伤患者100例,其中男81例,女19例;年龄18~72(40.5±9.5)岁。根据是否出现脓毒症进行分组,记录并比较两组的年龄、性别、体温、心率、血压、呼吸、损伤严重度评分(injury severity score,ISS)、创伤类型、血浆PCT及NGAL水平,并采用多因素Logistic回归分析多发伤并脓毒症的危险因素。结果单因素分析显示创伤类型、入院时血浆NGAL和PCT与多发伤并脓毒症有一定相关性(P0.05)。多因素Logistic回归分析显示入院时血浆NGAL的比值比(OR)值为3.427,95%可信区间(CI)为(1.984,5.415),入院时血浆PCT的OR值为6.247,95%CI为(3.965,9.862),是脓毒症的独立危险因素。入院时、入院后24 h及48 h时血浆NGAL及PCT脓毒症组均高于非脓毒症组,差异有统计学意义(P0.05)。结论血浆NGAL和PCT水平在一定程度上可预测多发伤患者是否合并脓毒症。     

降钙素原水平和序贯器官衰竭估计评分对脓毒症病情及预后的评估价值

目的分析降钙素原(PCT)水平和序贯器官衰竭估计评分(SOFA)对脓毒症病情及预后的评估价值。方法回顾79例患者资料,分析脓毒症严重程度、不同感染部位及预后脓毒症患者PCT水平及SOFA评分,比较其差异,分析PCT与SOFA相关性,及其对脓毒症预后的评估价值。结果 PCT水平及SOFA评分随着脓毒症严重程度增加而升高;腹腔感染患者PCT水平高于其他部位感染者;第5天PCT水平及SOFA评分对于脓毒症患者预后有一定预测价值,入院第1天死亡者与生存者PCT水平比较,差异未见统计学意义(P0.05)。PCT水平与SOFA评分呈正相关。结论 PCT水平对于腹腔感染患者诊断价值较高,PCT水平及SOFA评分在评估脓毒症严重度及预后上有一定意义,动态观察其变化对于判断脓毒症患者的病情及预后更有意义。     

PTX-3、copeptin、PCT血清水平变化与ICU脓毒症患者疾病转归的关联性分析

目的研究穿透素-3(PTX-3)、和肽素(copeptin)、降钙素原(PCT)血清水平变化与重症加强护理病房(ICU)脓毒症患者疾病转归的关联性。方法选取我院ICU脓毒症患者128例(2019年2月～2020年2月),及同期健康体检者60例。均检测血清PTX-3、copeptin、PCT水平,比较健康体检者、治疗前脓毒症患者及不同病情程度下血清PTX-3、copeptin、PCT水平,分析治疗前脓毒症患者血清指标水平与病情程度的相关性,并进行生存、死亡脓毒症患者临床资料比较,分析脓毒症患者死亡的Logistic多因素及血清PTX-3、copeptin、PCT水平、联合检测对死亡脓毒症患者的预测价值。结果脓毒症患者血清PTX-3、copeptin、PCT水平高于健康体检者,且随着病情程度加重,血清PTX-3、copeptin、PCT水平呈逐渐升高趋势(P0.05);经Spearman相关性分析,血清PTX-3、copeptin、PCT水平与病情程度呈正相关(P0.05);死亡脓毒症患者中脓毒症休克比例、血清PTX-3、copeptin、PCT水平高于生存患者(P0.05);经Logistic多因素分析,脓毒症休克、血清PTX-3、copeptin、PCT水平升高均为脓毒症患者死亡的危险因素(P0.05);受试者工作特征(ROC)曲线显示,联合预测脓毒症死亡的曲线下面积(AUC)值0.879大于PTX-3预测0.843、copeptin预测0.812、PCT预测0.785(P0.05)。结论 PTX-3、copeptin、PCT血清水平在ICU脓毒症患者中显著升高,且与病情程度、疾病转归密切相关,对预后情况的预测价值较高。     

降钙素原和乳酸动态变化对急诊老年严重脓毒症和脓毒性休克患者预后的评估价值

目的研究血浆降钙素原(Procalcitonin,PCT)和动脉血乳酸动态变化情况对老年严重脓毒症及脓毒性休克患者病情和预后的评估作用。方法收集首都医科大学宣武医院急诊监护室老年严重脓毒症和脓毒性休克患者163例,入院后给予PCT和动脉血乳酸等检查,并给与APACHEⅡ评分(Acute Physiology and Chronic Health EvaluationⅡ)。入院后6h复查血乳酸,5d复查PCT,随访28d根据预后患者分为死亡组和存活组,分别比较死亡组和存活组PCT和乳酸区别和2组乳酸和PCT的变化情况;比较脓毒性休克和严重脓毒症组的PCT,乳酸和APACHEⅡ评分的区别;用ROC曲线下面积(AUC)分析PCT和动脉血乳酸预测老年严重脓毒症和脓毒性休克患者死亡的价值。结果脓毒性休克组患者PCT、乳酸和APACHE II评分大于严重脓毒症组;死亡组PCT和乳酸均大于存活组(P0.05),6h乳酸和5d的PCT的差别更明显,死亡组乳酸和PCT前后比较无显著性差异(P0.05),存活组乳酸和PCT较前明显下降(P0.01);PCT预测死亡ROC曲线下面积为0.803,动脉血乳酸曲线下面积为0.796,两者比较无统计学差异(P0.05)。结论 PCT和动脉血乳酸对急诊老年严重脓毒症和脓毒性休克患者的病情和预后具有重要的评估价值,PCT和乳酸含量持续保持高水平的提示预后差。     

PCT、 LAC/ScvO2比值对脓毒症患者病情危重程度与预后的评估价值

目的:探讨降钙素原(PCT)、乳酸(LAC)与中心静脉血氧饱和度(ScvO2)的比值(LAC/ScvO2)对脓毒症患者病情危重程度与预后的评估价值。方法:选取2015-02—2018-04期间应城市人民医院重症医学科收治的脓毒症患者148例,入院后分别作PCT、LAC及ScvO2监测,依据患者病情分为脓毒症组(n=49)、严重脓毒症组(n=65)、脓毒症休克组(n=34),比较3组患者血清PCT水平、LAC/ScvO2及APACHEⅡ评分的差异,采用Pearson相关性分析PCT、LAC/ScvO2与APACHEⅡ评分的关系。另以28d为观察终点,以是否发生死亡将患者分为死亡组(n=52)和存活组(n=96),比较两组患者血清PCT水平、LAC/ScvO2的差异,并以是否死亡为状态变量,PCT、LAC/ScvO2为检验变量,绘制ROC曲线,分析PCT、LAC/ScvO2对脓毒症患者死亡的预测效能。结果:脓毒症组、严重脓毒症组、脓毒症休克组患者血清PCT水平、LAC/ScvO2、APACHEⅡ评分比较,均差异有统计学意义(P0.05);Pearson相关性分析显示,PCT、LAC/ScvO2与APACHEⅡ评分呈明显正相关(P0.05);存活组血清PCT水平、LAC/ScvO2和APACHEⅡ评分均明显低于死亡组(P0.05);ROC曲线显示,PCT、LAC/ScvO2预测脓毒症患者死亡的曲线下面积(AUC)分别为0.833、0.851,最佳临界值为2.65ng/ml和13.47,以两者联合对脓毒症患者死亡的预测效能最优,AUC、敏感度、特异度和准确性分别为0.896、90.38%、80.21%和83.78%。结论:PCT、LAC/ScvO2与脓毒症患者病情程度密切相关,两者联合预测脓毒症患者死亡的价值较单独应用PCT、LAC/ScvO2的价值更优。     

降钙素原结合APACHE Ⅱ评分在老年重症感染患者中的诊断和预后意义

目的评价血清降钙素原(PCT)结合急性生理与慢性健康(APACHEⅡ)评分在重症监护病房(ICU)老年重症感染患者中病情预测的价值。方法回顾性分析承德市中心医院ICU249例患者临床资料,根据临床表现、实验室检查,分为感染组131例,其中脓毒症48例,重度脓毒症43例,脓毒性休克40例;非感染组118例。比较两组PCT水平和APACHEⅡ评分结果。结果感染组PCT水平显著高于非感染组,差异有统计学意义(P<0.01);感染组中,PCT水平及APACHEⅡ评分均随病情加重而增高,差异有统计学意义(P<0.05)。PCT与APACHEⅡ评分显著相关(P<0.05)。结论PCT结合APACHEⅡ评分在指导ICU老年重症感染患者病情预测方面有重要临床参考价值。     

血清PCT、sTREM-1及NT-proBNP检测在新生儿脓毒症诊断评估中的价值

目的探讨血清降钙素原(PCT)、可溶性髓样细胞触发受体-1(sTREM-1)及N末端脑钠肽前体(NT-proBNP)在新生儿脓毒症诊断评估中的应用价值。方法将80例脓毒症患儿(观察组)根据NCIS评分分为非危重组43例,危重组26例和极危重组11例,另选取80例感染非脓毒症患儿为对照组。检测各组患儿血清PCT、sTREM-1及NT-proBNP水平,分析PCT、sTREM-1及NT-proBNP对新生儿脓毒症的诊断价值。结果观察组患儿血清PCT、sTREM-1及NT-proBNP水平明显高于对照组(P0.05)。随着病情的加重,脓毒症患儿血清PCT、sTREM-1及NT-proBNP水平也显著升高(P0.05)。观察组患儿血清PCT、sTREM-1及NT-proBNP水平之间均呈显著正相关(P0.05)。血清PCT、sTREM-1及NT-proBNP诊断新生儿脓毒症的ROC曲线下面积分别为0.888、0.821、0.803,其诊断灵敏度分别为80.0%、75.0%、60.0%,特异度为92.5%、76.2%、82.5%。结论血清PCT、sTREM-1及NTproBNP水平检测对新生儿脓毒症的诊断和病情评估具有重要临床价值。     

脓毒症患者血浆皮质醇水平与SOFA的相关性研究

目的:通过检测脓毒症患者血浆皮质醇(Cor)水平变化,分析其与SOFA的相关性,探讨其对脓毒症患者预后作用的评估价值。方法:脓毒症患者55例,健康体检者60例为对照组,入院24小时内分别检测其血浆Cor、ACTH水平、降钙素原(PCT)、血乳酸(LAC);按照脓毒症相关的序贯器官衰竭评分(sequential(sepsisrelated)organ failure assessment,SOFA)标准对脓毒症患者进行评分,比较两组患者血浆Cor水平变化。根据脓毒症患者预后分为生存组和死亡组,比较两组血浆Cor、ACTH水平变化;分析Cor水平与SOFA、PCT、LAC、MAP之间的相关性。结果:(1)脓毒症患者血浆Cor、ACTH分别高于对照组(P0.05);(2)脓毒症患者死亡组血浆Cor、ACTH水平及SOFA显著高于生存组(P0.05)。(3)脓毒症患者血浆Cor水平与PCT、LAC、SOFA呈正相关;与MAP呈负相关(P0.05)。结论:脓毒症患者发病早期机体激活下丘脑-垂体-肾上腺素轴,血浆Cor、ACTH水平明显升高。血浆Cor水平与SOFA呈正相关。     

Procalcitonin for early diagnosis and differentiation of SIRS,sepsis, severe sepsis,and septic shock

Objective To determine the value of procalcitonin (PCT) in the early diagnosis (and differentiation) of patients with SIRS, sepsis, severe sepsis, and septic shock in comparison to C-reactive protein (CRP), white blood cell and thrombocyte count, and APACHE-II score (AP-II). Design Prospective cohort study including all consecutive patients admitted to the ICU with the suspected diagnosis of infection over a 7-month period. Patients and methods A total of 185 patients were included: 17 patients with SIRS, 61 with sepsis, 68 with severe sepsis, and 39 patients with septic shock. CRP, cell counts, AP-II and PCT were evaluated on the first day after onset of inflammatory symptoms. Results PCT values were highest in patients with septic shock (12.89±4.39 ng/ml;P<0.05 vs patients with severe sepsis). Patients with severe sepsis had significantly higher PCT levels than patients with sepsis or SIRS (6.91±3.87 ng/ml vs 0.53±2.9 ng/ml;P<0.001, and 0.41±3.04 ng/ml;P<0.001, respectively). AP-II scores did not differ significantly between sepsis, severe sepsis and SIRS (19.26±1.62, 16.09±2.06, and 17.42±1.72 points, respectively), but was significantly higher in patients with septic shock (29.27±1.35,P<0.001 vs patients with severe sepsis). Neither CRP, cell counts, nor the degree of fever showed significant differences between sepsis and severe sepsis, whereas white blood cell count and platelet count differed significantly between severe sepsis and septic shock. Conclusions In contrast to AP-II, PCT appears to be a useful early marker to discriminate between sepsis and severe sepsis.     

Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study

Introduction

Sepsis, severe sepsis and septic shock are common conditions with high mortality. Their early diagnosis in the Emergency Department (ED) is one of the keys to improving survival. Procalcitonin (PCT) has been used as a biomarker in septic patients but has limited specificity and can be elevated in other scenarios of systemic inflammatory response syndrome (SIRS). Soluble CD14 (sCD14) or presepsin is the free fragment of a glycoprotein expressed on monocytes and macrophages. Preliminary reports suggest that levels of presepsin are significantly higher in septic patients than in healthy individuals. The aim of this study is to investigate the diagnostic and prognostic value of presepsin compared to PCT in people presenting at the ED with SIRS and suspected sepsis or septic shock.

Methods

This study was conducted in two major hospitals in Turin, Italy. One hundred six patients presenting to the EDs with suspected sepsis or septic shock were included, and another eighty-three patients affected by SIRS, but with no clinical evidence of infection, were recruited as controls. Blood samples were collected at first medical evaluation and for some patients after 24 and 72 h. The samples were analyzed using the PATHFAST Presepsin assay for sCD14, and commercial kits were used for other determinations (for example, PCT). Definitive diagnosis and survival rates were obtained afterward by analysis of digital medical records.

Results

Elevated concentrations of presepsin at presentation were observed in septic patients compared to control patients. The same trend was observed for mean values of PCT. Higher values of presepsin were observed in septic patients at presentation (time 0). The diagnostic accuracy of PCT was generally higher, and areas under the curve (AUCs) were 0.875 for PCT and 0.701 for presepsin. Mean presepsin values were significantly higher in nonsurvivor septic patients (60-day mortality) than in survivors. No significant correlation was noted between PCT and survival.

Conclusions

In our experience, presepsin was useful in the early diagnosis of infection in a complex population of patients with SIRS, sepsis, severe sepsis and septic shock who presented to the ED. Presepsin showed a significant prognostic value, and initial values were significantly correlated with in-hospital mortality of patients affected by sepsis, severe sepsis or septic shock.     

血清降钙素原和常用炎症指标结合SOFA评分对脓毒症早期诊断和预后价值的评价

目的 结合感染相关器官功能衰竭评分(SOFA)评价血清降钙素原(PCT)和临床常用炎症指标对脓毒症的早期诊断和预后价值.方法 采用前瞻性、临床病例观察及诊断试验研究.根据美国胸科医师协会/危重病医学会(ACCP/SCCM)共识会议,严格将入选病例分为全身炎症反应综合征(SIRS)组、脓毒症组、严重脓毒症组、脓毒性休克组、非SIRS对照组.测定24 h内的炎症指标、SOFA评分及PCT浓度并进行相关分析.结果 208例患者入选,其中对照组59例,SIRS组57例,脓毒症组52例,严重脓毒症组28例,脓毒性休克组12例.血清PCT浓度与脓毒症严重程度呈正相关,Spearman相关系数为0.909(P=0.000).根据受试者工作特征曲线(ROC曲线)分析,PCT的ROC曲线下面积(AUC)为0.936±0.020,SOFA评分的AUC为0.973±0.011(P均=0.000).判断最佳诊断界值PCT为＞0.375 μg/L,SOFA评分为＞3.5分,其约登(Youden)指数分别为0.808和0.801.二分类Logistic回归分析显示,在排除了年龄、CRP混杂因素后PCT和SOFA评分与脓毒症发病明显相关,相对危险度(OR值)分别为84.794和10.761(P均=0.000),并且可以预测脓毒症的发病概率.SOFA评分是脓毒症疾病预后的最显著因子,OR值为2.084(P=0.000 2).结论 传统炎症指标和C-反应蛋白(CRP)是鉴别SIRS和非SIRS的有用指标,但不是早期诊断脓毒症的可靠指标.PCT是早期诊断脓毒症并能与SIRS鉴别的特异性较高的炎症指标;结合SOFA评分和PCT可以预测脓度症的发病概率;根据PCT值的变化,再结合SOFA评分可以客观判断脓毒症病情的严重性.SOFA评分与脓毒症预后明显相关.     

Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock

Objective: To determine the value of procalcitonin (PCT) in the early diagnosis (and differentiation) of patients with SIRS, sepsis, severe sepsis, and septic shock in comparison to C-reactive protein (CRP), white blood cell and thrombocyte count, and APACHE-II score (AP-II).¶Design: Prospective cohort study including all consecutive patients admitted to the ICU with the suspected diagnosis of infection over a 7-month period.¶Patients and methods: A total of 185 patients were included: 17 patients with SIRS, 61 with sepsis, 68 with severe sepsis, and 39 patients with septic shock. CRP, cell counts, AP-II and PCT were evaluated on the first day after onset of inflammatory symptoms.¶Results: PCT values were highest in patients with septic shock (12.89 - 4.39 ng/ml; P < 0.05 vs patients with severe sepsis). Patients with severe sepsis had significantly higher PCT levels than patients with sepsis or SIRS (6.91 - 3.87 ng/ml vs 0.53 - 2.9 ng/ml; P < 0.001, and 0.41 - 3.04 ng/ml; P < 0.001, respectively). AP-II scores did not differ significantly between sepsis, severe sepsis and SIRS (19.26 - 1.62, 16.09 - 2.06, and 17.42 - 1.72 points, respectively), but was significantly higher in patients with septic shock (29.27 - 1.35, P < 0.001 vs patients with severe sepsis). Neither CRP, cell counts, nor the degree of fever showed significant differences between sepsis and severe sepsis, whereas white blood cell count and platelet count differed significantly between severe sepsis and septic shock.¶Conclusions: In contrast to AP-II, PCT appears to be a useful early marker to discriminate between sepsis and severe sepsis.     

降钙素原联合血小板检测对脓毒症诊断及判断预后的临床意义

目的探讨降钙素原(PCT)联合血小板(PLT)对脓毒症的诊断及判断预后的意义。方法收集160例ICU危重全身炎症反应综合征(SIRS)患者,按脓毒症诊断标准分为脓毒症组与对照组,按是否发生脓毒性休克,将脓毒症组分为非脓毒性休克组与脓毒性休克组。所有患者急性生理学及慢性健康状况评分系统(APACHEⅡ)评分大于10分。收集入院24hAPACHEⅡ评分、序贯器官衰竭估计(SOFA)评分、白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、血小板计数(PLT)情况。采用SPSS21.0统计软件进行统计分析,比较非脓毒性休克组、脓毒性休克组和对照组间的PLT、CRP、PCT差异,脓毒症组PCT、PLT与SOFA、APACHEⅡ评分的相关性采用Pearson相关分析,绘制受试者工作特征(ROC)曲线确定PCT、PLT的诊断价值。结果脓毒症组PLT明显低于对照组,脓毒性休克组PLT明显低于非脓毒性休克组,脓毒症组CRP、PCT明显高于对照组,脓毒性休克组CRP、PCT明显高于非脓毒性休克组,差异均有统计学意义(P0.05)。Pearson相关分析显示,脓毒症组PCT与SOFA、APACHEⅡ评分呈显著正相关,PLT与二者呈显著负相关。ROC曲线确定PLT≤100×10~9/L,PCT≥2.0μg/L为最佳截点值,ROC曲线下面积(AUC)分别为0.839、0.857,灵敏度分别为89.4%、87.4%,特异度分别为74.2%、69.8%。结论 PCT联合PLT对脓毒症诊断具有较高的临床意义。     

降钙素原与内毒素在危重症患者脓毒症早期诊断及预后的价值研究

目的评价降钙素原(PCT)与内毒素(ET)检测在危重症患者脓毒症早期诊断及预后价值。方法前瞻性收集2015年2月至2016年10月该院重症医学科(ICU)收治疑似脓毒症患者为研究对象,有104例纳入此项研究。其中,全身炎症反应综合征31例(SIRS组),脓毒症30例(脓毒症组),严重脓毒症24例(严重脓毒症组),脓毒症休克19例(脓毒症休克组)。以脓毒症患者出院作为观察预后,共存活57例(存活组),死亡16例(死亡组)。检测所有患者入院时PCT、ET水平并收集相关临床资料,运用受试者工作特征曲线(ROC)评价各指标的效能。结果脓毒症组、严重脓毒症组、脓毒症休克组PCT水平、APACHE-Ⅱ评分、ET水平均明显高于SIRS组,且差异具有统计学意义(P0.05)。PCT水平和慢性健康状况评分Ⅱ(APACHE-Ⅱ评分)随着感染程度的严重而升高(P0.05),ROC曲线显示PCT诊断脓毒症的敏感性为82.2%,特异性为87.5%。PCT水平和APACHE-Ⅱ评分在死亡组水平更高,且差异有统计学意义(P0.05),而ET水平在两组间差异无统计学意义(P0.05),ROC曲线显示,PCT预测脓毒症患者死亡的曲线下面积(AUC)为0.867要显著高于APACHE-Ⅱ评分的0.762,且差异有统计学意义(P0.05)。结论相比APACHE-Ⅱ评分和ET,PCT检测更有助于临床医师早期诊断和治疗脓毒症患者。     

Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department

Introduction

Presepsin levels are known to be increased in sepsis. The aim of this study was to evaluate the early diagnostic and prognostic value of Presepsin compared with procalcitonin (PCT), Mortality in Emergency Department Sepsis (MEDS) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score in septic patients in an emergency department (ED) and to investigate Presepsin as a new biomarker of sepsis.

Methods

This study enrolled 859 consecutive patients with at least two diagnostic criteria for systemic inflammatory response syndrome (SIRS) who were admitted to Beijing Chao-yang Hospital ED from December 2011 to October 2012, and 100 age-matched healthy controls. Patients were stratified into four groups: SIRS, sepsis, severe sepsis, and septic shock. Plasma Presepsin and serum PCT were measured, and MEDS score and APACHE II score were calculated at enrollment. Comparisons were analyzed using the Kruskal-Wallis and Mann–Whitney U tests.

Results

On admission, the median levels of plasma Presepsin increased with sepsis severity. The areas under the receiver operating characteristic (AUC) curves of Presepsin were greater than those of PCT in diagnosing sepsis, and predicting severe sepsis and septic shock. The AUC of Presepsin for predicting 28-day mortality in septic patients was slightly lower than that of PCT, MEDS score and APACHE II score. The AUC of a combination of Presepsin and MEDS score or APACHE II score was significantly higher than that of MEDS score or APACHE II score alone in predicting severe sepsis, and was markedly higher than that of Presepsin alone in predicting septic shock and 28-day mortality in septic patients, respectively. Plasma Presepsin levels in septic patients were significantly higher in non-survivors than in survivors at 28 days’ follow-up. Presepsin, MEDS score and APACHE II score were found to be independent predictors of severe sepsis, septic shock and 28-day mortality in septic patients. The levels of plasma Presepsin were positively correlated with PCT, MEDS score and APACHE II score in every septic group.

Conclusion

Presepsin is a valuable biomarker for early diagnosis of sepsis, risk stratification, and evaluation of prognosis in septic patients in the ED.     

Presepsin在脓毒症早期诊断和预后评估中应用价值

目的探讨血浆Presepsin水平对脓毒症的诊断和预后评估的临床意义。方法 90例脓毒症患者根据是否休克分为脓毒症组和脓毒症休克组各45例,体检健康者45例为对照组,检测并比较3组血浆Presepsin、降钙素原(procalcitonin, PCT)、高敏C反应蛋白(high-sensitivity C-reactive protein, hs-CRP)水平;比较脓毒症休克组与脓毒症组小儿危重症评分、SOFA评分、白细胞计数、血小板计数、乳酸、B型钠尿肽原水平,比较脓毒症患者中死亡者(死亡组)与存活者(存活组)血浆Presepsin、PCT和hs-CRP水平、小儿危重症评分和SOFA评分,采用Spearman相关分析Presepsin与PCT、hs-CRP、小儿危重症评分、SOFA评分的相关性;采用ROC曲线评估Presepsin、PCT、hs-CRP对脓毒症的诊断效能。结果脓毒症休克组患者血浆Presepsin[(1 581.74±1 142.54)ng/L]、PCT[(3 242.61±1 693.47)ng/L]和hs-CRP[(159.47±85.78)mg/L]水平明显高于脓毒症组[(279.78±123.57)ng/L、(2 158.96±1 529.77)ng/L、(116.74±71.85)mg/L]和对照组[(67.71±33.15)ng/L、(7.79±5.52)ng/L、(2.51±1.47)mg/L](P<0.05),脓毒症组高于对照组(P<0.05);脓毒症休克组患者SOFA评分及乳酸、B型钠尿肽原水平高于脓毒症组(P<0.05),小儿危重症评分、血小板计数、白细胞计数低于脓毒症组(P<0.05);死亡组血浆Presepsin、PCT、hs-CRP水平及小儿危重症评分、SOFA评分均明显高于存活组(P<0.05);血浆Presepsin水平与血浆PCT、hs-CRP水平、SOFA评分均呈正相关(r=0.714,P<0.001;r=0.756,P<0.001;r=0.838,P<0.001),与小儿危重症评分呈负相关(r=-2.787,P<0.001);血浆Presepsin水平诊断脓毒症的AUC(0.924)、灵敏度(72.0%)和特异度(90.0%)均高于PCT(0.684、60.0%、80.0%)和hs-CRP(0.617、50.0%、70.0%)(P<0.05)。结论检测血浆Presepsin水平有助于脓毒症的早期诊断、病情程度判断和预后评估。     

Early diagnosis of septic arthritis using synovial fluid presepsin: A preliminary study

Therapeutic outcomes for septic arthritis vary greatly depending on the span of time between disease-onset and surgery. The most important factor is making an early and definitive diagnosis; however, some cases may be difficult to diagnose. We investigated presepsin, a biomarker of sepsis, to determine whether or not presepsin in synovial fluid would be useful for the diagnosis of septic arthritis. We selected 18 patients with septic arthritis including periprosthetic joint infections (SA group) and 28 patients with osteoarthritis (OA group). We measured the concentrations of synovial fluid presepsin, blood presepsin and procalcitonin (PCT) in the two groups. We compared the sensitivities and specificities of synovial fluid presepsin, blood presepsin and PCT. Synovial fluid and blood presepsin and blood PCT were all significantly higher in the SA group. Synovial fluid presepsin exhibited both 100% sensitivity and 100% specificity in the SA group, which were higher rates than those for blood presepsin and PCT. We found that synovial fluid presepsin is markedly elevated in case of septic arthritis, and therefore, it has potential as a new biomarker of septic arthritis.     

血浆PCT和CRP水平的动态变化对脓毒症严重程度的评估及其相关性研究

目的探讨动态监测血浆PCT和CRP水平在评估脓毒症患者严重程度的临床意义及其相关性研究。方法选择2009年9月至2011年9月我院ICU入住的脓毒症患者114例,在入科的第1,3,5,7天抽取外周血检测PCT、CRP水平,同时行血培养,根据血培养结果分为血培养阳性组和血培养阴性组,根据脓毒症严重程度分为脓毒症组、严重脓毒症组、脓毒性休克组,比较各组PCT、CRP水平有无差异及各指标之间的相关性。结果 （1）在脓毒症血培养阳性组第1、3、5、7天PCT水平及第1、3天的CRP水平明显高于血培养阴性组,ROC曲线图显示,在诊断是否存在血行性感染上,PCT具有较高的特异性和敏感性;（2）在脓毒症组、严重脓毒症组、脓毒性休克组,随着感染程度加重,PCT水平与CRP水平均呈上升趋势,以PCT和CRP来诊断严重脓毒症或脓毒性休克的ROC曲线图所示,PCT较CRP具有较高的敏感性和特异性。结论脓毒症患者血浆PCT水平较CRP水平与疾病严重程度有着更明显的相关性,动态监测PCT水平变化趋势有助于脓毒症严重程度的判断及指导治疗。