降钙素原及血培养阳性时间对严重败血症早期预后的价值  

Value of procalcitonin and time to blood culture positivity in early prediction of survival outcome of patients with sever sepsis

作　　者：叶晓涛[1] 习慧明[2] 张旭[1] 许瑞环[1] 

机构地区：[1]深圳市龙岗中心医院检验科,广东深圳518116 [2]北京协和医院检验科,北京100730

出　　处：《中华医院感染学杂志》2013年第16期4075-4077,共3页Chinese Journal of Nosocomiology

基　　金：广东省深圳市科技计划项目(201203318);深圳市龙岗区科技计划医疗卫生资助项目(ys2012198)

摘　　要：目的评估降钙素原(PCT)及血培养阳性时间(TTP)对严重败血症患者早期预后的应用价值,为临床治疗监护提供理论依据。方法分析77例血培养阳性严重败血症患者临床资料和细菌分布;比较PCT和TTP的ROC曲线特性。结果严重败血症患者感染的病原菌主要为革兰阴性杆菌占74.0%,其中大肠埃希菌占36.3%;死亡组与生存组PCT的中位数分别为20.04ng/ml和5.15ng/ml,死亡组与生存组TTP的中位数分别为10.50h和12.91h,PCT和TTP在死亡组与生存组间差异均有统计学意义(P<0.01);死亡组对应生存组PCT和TTP检测的ROC曲线下面积分别是0.870和0.727,95%置信区间为0.790～0.950和0.598～0.856,最优截断点为5.25ng/ml和9.1h,灵敏度为88.5%和65.4%,特异度为76.5%和74.5%。结论大肠埃希菌是引起败血症最主要病原菌;PCT早期预测严重败血症患者死亡危险性有较好的准确性和灵敏度,且优于TTP;血浆PCT检测联合TTP评估严重败血症患者预后有更好的临床应用价值。OBJECTIVE To assess the value of application of procalcitonin（PCT）and time to blood culture positivity（TTP）in the early prognosis of the severe sepsis patients so as to provide theoretical basis for the clinical treatment.METHODS The clinical data of 77severe sepsis patients with positive blood culture were analyzed,and the distribution of the pathogens was observed;the characteristics of receiver operating characteristic curve（ROC） were compared between the PCT and the TTP.RESULTS The gram-negative bacilli were the predominant pathogens causing severe sepsis,accounting for 74.0%,among which Escherichia coli was the most common sepsis,accounting for 36.3%.The median of PCT were 20.04ng/ml and 5.15ng/ml,respectively,the median of TTP were 10.50hours and 12.91hours,respectively,the determination of PCT and TTP were significantly statistical between non-survival group and the survival group（P0.01）.The area under ROC curve（AUC）of the determination of PCT and TTP between non-survival group and the survival group were 0.870and 0.727,respectively,the asymptotic 95% Confidence Interval（95%CI）were 0.790～0.950and 0.598～0.856,respectively,the optimal cut off value were 5.25ng/ml and 9.1hours,the sensitivity were 88.5%and 65.4%,the specificity were 76.5% and 74.5%,respectively.CONCLUSION E.coli is the most common species of pathogens causing the sepsis;the PCT is superior to the TTP in early prediction of mortality of the severe sepsis patients,with the accuracy and sensitivity better.Concurrent determination of plasma PCT and TTP could provide better clinical value in the early prognosis of the severe sepsis patients.

关 键 词：降钙素原 败血症 血培养阳性时间 ROC曲线 

分 类 号：R446[医药卫生—诊断学]