Plasma endothelin-1 levels in septic patients

Dysfunction of the vascular endothelium (ET) causes an increase in serum ET-1 concentration, as observed in septic patients. It was assumed that in this patient population the ET-1 level correlates with the degree of sepsis severity, including the level of organ dysfunction and, in particular, the level of circulatory dysfunction. The aim of the present study was to assess the relationship between levels of ET-1 and levels of N-terminal brain natriuretic propeptide (NT-proBNP), procalcitonin (PCT), and C-reactive protein (CRP), as well as the Sepsis-related Organ Failure Assessment (SOFA) score in septic patients. PCT and CRP were used to estimate the level of sepsis severity; the SOFA score was used to estimate multiorgan dysfunction; and NT-proBNP was used as a marker of cardiac dysfunction. Twenty patients with sepsis and severe sepsis were included in the study. Blood serum ET-1, NT-proBNP, PCT, and CRP concentrations were determined at specific time intervals, and the SOFA score was calculated. Mean ET-1, NT-proBNP, PCT, and CRP concentrations were 8.39 pg/ml +/- 6.39 pg/mL, 140.80 pg/mL +/- 84.65 pg/mL, 22.32 ng/mL +/- 97.41 ng/mL, and 128.51 mg/L +/- 79.05 mg/L, respectively. Correlation between ET-1 levels and levels of NT-proBNP, PCT, and CRP was .3879 (P < .001), .358 (P < .001), and .225 (P = .011), respectively. Mean SOFA score was 6.31 pts +/- 3.75 pts. Correlation between the ET-1 levels and SOFA score was .470 (P < .001). Six patients (30%) died during the observation period of 28 days. ET-1 levels correlate with levels of NT-proBNP, PCT, and CRP, as well as the SOFA score in septic patients.     

Comparison of procalcitonin and C-reactive protein as markers of sepsis

OBJECTIVE: To compare the clinical informative value of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations in the detection of infection and sepsis and in the assessment of severity of sepsis. DESIGN: Prospective study. SETTING: Medicosurgical intensive care unit. PATIENTS: Seventy consecutive adult patients who were admitted to the intensive care unit for an expected stay >24 hrs. INTERVENTIONS: None. MEASUREMENTS: PCT and CRP plasma concentrations were measured daily during the intensive care unit stay. Each patient was examined daily for signs and symptoms of infection and was classified daily in one of the following four categories according to the American College of Chest Physicians/Society of Critical Care Medicine criteria: negative, systemic inflammatory response syndrome, localized infection, and sepsis group (sepsis, severe sepsis, or septic shock). The severity of sepsis-related organ failure was assessed by the sepsis-related organ failure assessment score. MAIN RESULTS: A total of 800 patient days were classified into the four categories. The median plasma PCT concentrations in noninfected (systemic inflammatory response syndrome) and localized-infection patient days were 0.4 and 1.4 ng/mL (p <.0001), respectively; the median CRP plasma concentrations were 79.9 and 85.3 mg/L (p =.08), respectively. The area under the receiver operating characteristic curve was 0.756 for PCT (95% confidence interval [CI], 0.675-0.836), compared with 0.580 for CRP (95% CI, 0.488-0.672) (p <.01). The median plasma PCT concentrations in nonseptic (systemic inflammatory response syndrome) and septic (sepsis, severe sepsis, or septic shock) patient days were 0.4 and 3.65 ng/mL (p <.0001), respectively, whereas those for CRP were 79.9 and 115.6 mg/L (p <.0001), respectively. The area under the receiver operating characteristic curve was 0.925 for PCT (95% CI, 0.899-0.952), compared with 0.677 for CRP (95% CI, 0.622-0.733) (p <.0001). The linear correlation between PCT plasma concentrations and the four categories was much stronger than in the case of CRP (Spearman's rho, 0.73 vs. 0.41; p <.05). A rise in sepsis-related organ failure assessment score was related to a higher median value of PCT but not CRP. CONCLUSION: PCT is a better marker of sepsis than CRP. The course of PCT shows a closer correlation than that of CRP with the severity of infection and organ dysfunction.     

Serum cytochrome c level as a prognostic indicator in patients with systemic inflammatory response syndrome

BACKGROUND: Apoptosis may play an important role in the development of systemic inflammatory response syndrome (SIRS) and progression to multiple organ dysfunction syndrome (MODS). To quantify the extent of apoptosis in these morbidities, we developed a sandwich ELISA system to measure serum cytochrome c (cyt-c) levels and we investigated the prognostic significance of cyt-c concentration in SIRS/MODS patients. METHODS: Cyt-c concentrations in patients with SIRS (n=53) with or at risk for MODS were measured and compared with those of control subjects (n=14). RESULTS: Cyt-c concentrations in SIRS/MODS patients increased (0.24-210 ng/ml), whereas those in control subjects were under detection limits (0.1 ng/ml). Cyt-c concentrations in non-survivors increased significantly compared with those in survivors both on the day of admission and on the fifth hospital day. A significant positive correlation was found between cyt-c concentration and two representative organ dysfunction scores, APACHE II and multi-organ failure (MOF) score. Cyt-c concentrations increased earlier than MOF score during the exacerbation phase and rapidly decreased during the convalescence phase in a survivor, but the level continued to be high in a non-survivor. CONCLUSIONS: Determination of serum cyt-c concentrations may be useful to assess the severity of organ dysfunction and to predict the prognosis of SIRS/MODS patients.     

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.     

Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients

OBJECTIVE: To compare procalcitonin (PCT) plasma levels of injured patients with the incidence and severity of systemic inflammatory response syndrome (SIRS), infection, and multiple organ dysfunction syndrome (MODS) and to assess the predictive value of PCT for these posttraumatic complications. DESIGN: Retrospective study comparing patients with mechanical trauma in terms of severity of injury, development of infectious complications, and organ dysfunctions. SETTING: Level I trauma center with emergency room, intensive care unit, and research laboratory. PATIENTS: Four hundred five injured patients with an Injury Severity Score of > or =9 points were enrolled in this study from January 1994 to February 1996. INTERVENTIONS: Blood samples were collected on the day of admission and on days 1, 3, 5, 7, 10, 14, and 21 thereafter. MEASUREMENTS AND MAIN RESULTS: We determined PCT serum levels using a specific immunoluminometric assay. We retrospectively evaluated the occurrence of SIRS, sepsis, and MODS using patients' charts. Mechanical trauma led to increased PCT plasma levels dependent on the severity of injury, with peak values on days 1 and 3 (p < .05) and a continuous decrease within 21 days after trauma. Patients who developed SIRS demonstrated a significant (p < .05) increase of peak PCT plasma levels compared with patients without SIRS. The highest PCT plasma concentrations early after injury were observed in patients with sepsis (6.9+/-2.5 ng/mL; day 1) or severe MODS (5.7+/-2.2 ng/mL; day 1) with a sustained increase (p < .05) for 14 days compared with patients with an uneventful posttraumatic course (1.1+/-0.2 ng/mL). Moreover, these increased PCT plasma levels during the first 3 days after trauma predicted (p < .0001; logistic regression analysis) severe SIRS, sepsis, and MODS. CONCLUSIONS: These data indicate that PCT represents a sensitive and predictive indicator of sepsis and severe MODS in injured patients. Routine analysis of PCT levels seems to aid early recognition of these posttraumatic complications. Thus, PCT may represent a useful marker to monitor the inflammatory status of injured patients at risk.     

Comparison of Sepsis-related Organ Failure Assessment (SOFA) score and CIS (cellular injury score) for scoring of severity for patients with multiple organ dysfunction syndrome (MODS)

OBJECTIVE: To evaluate the usefulness of cellular injury score (CIS) and Sepsis-related Organ Failure Assessment (SOFA) score for determination of the severity of multiple organ dysfunction syndrome (MODS). DESIGN: A prospective observational study. SETTING: A medical and surgical intensive care unit (ICU) of a teaching hospital. Patients: Forty-seven consecutive MODS patients. MEASUREMENTS AND RESULTS: SOFA score and CIS were measured every day for 12 months for 47 MODS patients. Comparison was made of the SOFA score and CIS for usefulness in the scoring of severity of MODS in 26 survivors and 21 non-survivors. In addition, receiver operating characteristics (ROC) analysis was used to determine the usefulness of these two indexes as predictors of prognosis. No significant differences were found on admission between the survivors and non-survivors, but significant differences between the two subgroups (p < 0.001) were found in maximum value within 1 week after admission and maximum value during the course of treatment for both indexes. Analysis of changes after admission indicated that significant differences between survivors and non-survivors began to appear on day 3 of admission for both indexes; at that time SOFA score began to deteriorate in the non-survivors while CIS began to improve in the survivors. ROC analysis demonstrated that the area under the ROC curve was 0.769 for SOFA scores and 0.760 for CIS. CONCLUSIONS: Both SOFA score and CIS sequentially reflected the severity of MODS. Furthermore, they were comparable in diagnostic value as predictors of prognosis. These findings may indicate the possibility that MODS is a summation of effects of cellular injury. In addition, sequential evaluation of both SOFA score and CIS would provide a more accurate prediction of prognosis than conventional methods.     

The Multiple Organ Dysfunction Score (MODS) versus the Sequential Organ Failure Assessment (SOFA) score in outcome prediction

OBJECTIVE: To compare outcome prediction using the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA), two of the systems most commonly used to evaluate organ dysfunction in the intensive care unit (ICU). DESIGN: Prospective, observational study. SETTING: Thirty-one-bed, university hospital ICU. PATIENTS AND PARTICIPANTS: Nine hundred forty-nine ICU patients. MEASUREMENTS AND RESULTS: The MODS and the SOFA score were calculated on admission and every 48 h until ICU discharge. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was calculated on admission. Areas under receiver operating characteristic (AUROC) curves were used to compare initial, 48 h, 96 h, maximum and final scores. Of the 949 patients, 277 died (mortality rate 29.1%). Shock was observed in 329 patients (mortality rate 55.3%). There were no significant differences between the two scores in terms of mortality prediction. Outcome prediction of the APACHE II score was similar to the initial MODS and SOFA score in all patients, and slightly worse in patients with shock. Using the scores' cardiovascular components (CV), outcome prediction was better for the SOFA score at all time intervals (initial AUROC SOFA CV 0.750 vs MODS CV 0.694, p<0.01; 48 h AUROC SOFA CV 0.732 vs MODS CV 0.675, p<0.01; and final AUROC SOFA CV 0.781 vs MODS CV 0.674, p<0.01). The same tendency was observed in patients with shock. There were no significant differences in outcome prediction for the other five organ systems. CONCLUSIONS: MODS and SOFA are reliable outcome predictors. Cardiovascular dysfunction is better related to outcome with the SOFA score than with the MODS.     

不同风险评估系统和炎性指标对重症老年机械通气患者撤机结果的预测价值

目的探讨不同风险评估系统及炎性指标对重症老年机械通气患者撤机结果的预测价值分析。方法选取四川省达州市中西医结合医院2016年10月-2018年12月ICU收治的136例需要机械通气的老年患者作为研究对象,于撤机前对所有患者进行APACHE II、SAPS II、MODS、SOFA、CPIS风险评估,并检测患者血清炎性指标(PCT、CRP、PTX-3、HRG)。按拔管结果分为撤机成功组和撤机困难组,使用ROC曲线分析各风险评估系统结果及炎性指标对拔管结果预测的敏感性及特异性。结果撤机成功76例,失败60例。撤机成功组APACHE II、SAPS II、MODS、SOFA、CPIS等评分均显著低于撤机困难组,组间比较差异有统计学意义(P<0.05);风险评估系统APACHE II、SAPS II、MODS、SOFA、CPIS预测机械通气的ICU患者预后情况均具有较高效能,其中SAPS II的AUC值较高,其cut-off值为26.63,敏感性为89.53%,特异性为85.05%。炎性指标PCT、CRP、PTX-3、HRG预测机械通气的ICU患者预后情况均具有较高效能,其中PTX-3的AUC值最大,显著高于其它各指标(P<0.05),其cut-off值为33.82,敏感性为68.42%,特异性为93.33%。SAPS II评分和PTX-3作为联合指标预测机械通气的ICU患者预后的敏感度为94.74%,特异度为86.67%。结论风险评估系统APACHE II、SAPS II、MODS、SOFA、CPIS均可用于预测机械通气的ICU患者预后,其中SAPS II较优。炎性指标PTX-3预测机械通气的ICU患者预后效果好,优于PCT、CRP、HRG等指标。SAPS II评分联合PTX-3预测老年机械通气的ICU患者预后效果更佳。     

Usefulness of procalcitonin for diagnosing complicating sepsis in patients with cardiogenic shock

Objective Patients in cardiogenic shock (CS) often present with signs of systemic inflammation that mimic infection, especially in the setting of multiple organ failure (MOF). To clarify the usefulness of procalcitonin (PCT) for diagnosing complicating sepsis in patients with CS, especially in the presence of MOF we compared PCT concentrations in patients with CS with and without MOF to those in patients with septic shock (SS).Design and setting Retrospective analysis in the cardiovascular ICU at a university hospital.Patients 40 patients with CS, 15 patients with SS, and 11 noncritically ill patients without infection.Measurements and results Infection was excluded by clinical and microbiological examination in all CS patients at the time of blood sampling. Nevertheless 35% exhibited CRP concentrations higher than 10 mg/dl and 25% PCT concentrations higher than 2 ng/ml. Median PCT concentrations were higher in CS patients than in controls but lower than in patients with SS. CS patients with MOF at the time of blood sampling exhibited higher PCT concentrations than patients without organ failure. In the pooled population of patients with CS and SS PCT had a higher area under the receiver operating characteristic curve (0.86 vs. 0.83) than CRP and a PCT concentration of 10 ng/ml or higher had greater specificity for sepsis than a PCT concentration of 2 ng/ml or higher but lower negative predictive value.Conclusions PCT concentrations above 2 ng/ml are frequently found in CS patients with MOF and do not necessarily indicate infection. PCT was slightly better than CRP for diagnosing sepsis in our study, but a PCT concentration of 10 ng/ml or higher seems to be more appropriate for diagnosing this complication in CS patients than 2 ng/ml.     

Procalcitonin for discrimination between activity of systemic autoimmune disease and systemic bacterial infection

Objective To investigate whether serum procalcitonin (PCT) levels could be useful to differentiate between systemic infection and the activity of the underlying disease in autoimmune disease. Methods In 18 patients with systemic lupus erythematodes (SLE) and 35 patients with systemic antineutrophil cytoplasmic antibody-associated vasculitis (AAV) clinical disease activity was assessed by score systems. Infection was defined by clinical and microbiological means. PCT was determined in parallel with concentrations of neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP) in 397 serum samples. Results Only in 3 of the 324 samples taken from patients with autoimmune disease but without concomitant infection, serum PCT levels were above the normal range (>0.5 ng/ml), whereas neopterin, CRP and IL-6 were elevated in patients with active underlying disease. All systemic infections (N=16 in AAV-patients) were associated with markedly elevated PCT-levels (mean±SD:1.93±1.19 ng/ml). Conclusion PCT may serve as a useful marker for the detection of systemic bacterial infection in patients with autoimmune disease.     

Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children

OBJECTIVES: To analyse the clinical value of procalcitonin (PCT), C-reactive protein (CRP) and leucocyte count in the diagnosis of paediatric sepsis and in the stratification of patients according to severity. DESIGN: Prospective, observational study. SETTING: Paediatric intensive care unit (PICU). PATIENTS: Ninety-four children. MEASUREMENT AND RESULTS: Leucocyte count, PCT and CRP were measured when considered necessary during the PICU stay. Patients were classified, when PCT and CRP were measured, into one of six categories (negative, SIRS, localized infection, sepsis, severe sepsis, and septic shock) according to the definitions of the American College of Chest Physicians /Society of Critical Care Medicine. A total of 359 patient day episodes were obtained. Leucocyte count did not differ across the six diagnostic classes considered. Median plasma PCT concentrations were 0.17, 0.43, 0.79, 1.80, 15.40 and 19.13 ng/ml in negative, systemic inflammatory response syndrome (SIRS), localized infection, sepsis, severe sepsis, and septic shock groups, respectively, whereas median plasma CRP concentrations were 1.35, 3.80, 6.45, 5.70, 7.60 and 16.2 mg/dl, respectively. The area under the ROC curve for the diagnosis of septic patients was 0.532 for leucocyte count (95% CI, 0.462-0.602), 0.750 for CRP (95% CI, 0.699-0.802) and 0.912 for PCT (95% CI, 0.882-0.943). We obtained four groups using CRP values and five groups using PCT values that classified a significant percentage of patients according to the severity of the different SIRS groups. CONCLUSIONS: PCT is a better diagnostic marker of sepsis in critically ill children than CRP. The CRP, and especially PCT, may become a helpful clinical tool to stratify patients with SIRS according to disease severity.     

Procalcitonin and C-reactive protein during systemic inflammatory response syndrome,sepsis and organ dysfunction

Introduction  

Both C-reactive protein (CRP) and procalcitonin (PCT) are accepted sepsis markers. However, there is still some debate concerning the correlation between their serum concentrations and sepsis severity. We hypothesised that PCT and CRP concentrations are different in patients with infection or with no infection at a similar severity of organ dysfunction or of systemic inflammatory response.     

Procalcitonin for discrimination between activity of systemic autoimmune disease and systemic bacterial infection

Objective: To investigate whether serum procalcitonin (PCT) levels could be useful to differentiate between systemic infection and the activity of the underlying disease in autoimmune disease.¶Methods: In 18 patients with systemic lupus erythematodes (SLE) and 35 patients with systemic antineutrophil cytoplasmic antibody-associated vasculitis (AAV) clinical disease activity was assessed by score systems. Infection was defined by clinical and microbiological means. PCT was determined in parallel with concentrations of neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP) in 397 serum samples.¶Results: Only in 3 of the 324 samples taken from patients with autoimmune disease but without concomitant infection, serum PCT levels were above the normal range ( > 0.5 ng/ml), whereas neopterin, CRP and IL-6 were elevated in patients with active underlying disease.¶All systemic infections (N = 16 in AAV-patients) were associated with markedly elevated PCT-levels (mean - SD:1.93 - 1.19 ng/ml).¶Conclusion: PCT may serve as a useful marker for the detection of systemic bacterial infection in patients with autoimmune disease.     

血清降钙素原与多器官功能障碍综合征严重程度相关性的临床研究

目的 研究血清降钙素原(PCT)水平与多器官功能障碍综合征(MODS)严重程度的相关性。 方法 对61例MODS患者(其中感染组40例,非感染组21例)采用微量双夹心免疫发光法测定血清PCT 水平,并记录其急性生理学与慢性健康状况Ⅱ(APACHE Ⅱ)评分和Marshall评分,采用线性回归分析方法分 析血清PCT水平与APACHEⅡ评分的相关性。结果 MODS患者血清PCT水平呈不同程度升高;感染组血 清PCT[13．01(2．73,64．79)μg／L]、APACHEⅡ评分[(17．50±5．35)分]与Marshall评分[(6．38±2．46)分] 明显高于非感染组(1．50(0,2．98)μg／L、(14．67±3．01)分和(4．62±2．01)分,P<0．05或P<0．0013;感染组 与非感染组血清PCT水平与APACHEⅡ评分不相关(r=0．175,P=0．281;r=0．071,P=0．759),全部 MIDDS患者血清PCT水平与APACHEⅡ评分也无明显相关性(r=0．229,P=0．076);全部MODS患者血清 PCT水平与Marshall评分显著相关(r=0．514,P<0．001),但感染组的r值更高(r=0．535,P<0.001),非感 染组血清PCT水平与Marshall评分不相关(r=0．003,P=0．991)。结论 检测血清PCT对判断感染导致的 MODS患者病情严重程度具有重要的临床价值。     

多器官功能障碍综合征患者高级氧化蛋白产物的表达及其临床意义

目的 探讨高级氧化蛋白产物(AOPP)在多器官功能障碍综合征(MODS)发病中的作用及临床意义.方法 选择全身炎症反应综合征(SIRS)和MODS患者各90例.采用分光光度计法测定患者静脉血中C-反应蛋白(CRP)和AOPP的浓度;同时对MODS患者进行急性生理学与慢性健康状况评分系统Ⅲ(APACHE Ⅲ)评分,追踪患者1个月内的生存或死亡情况;分析CRP和AOPP浓度与器官功能障碍程度和病情转归的关系.以同期90例与患者年龄、性别相匹配的健康体检者作为健康对照组.结果 MODS组患者血CRP[(22.22±4.32)mg/L3和AOPP[(130.66±18.08)μmol/L]浓度均显著高于健康对照组[(2.38±0.89)mg/L和(33.20±5.32)μmol/L3和SIRS组[(5.32±1.22)mg/L和(48.58±6.03)μmol/L],差异均有统计学意义(P均<0.05),健康对照组与SIRS组间差异无统计学意义.MODS组中死亡患者(47例)血CRP和AOPP浓度显著高于存活患者(43例,P均<0.05);MODS患者血CRP、AOPP浓度与APACHE Ⅲ评分E(98.66±20.87)分]均呈高度正相关(rl=0.469,r2=0.528,P均<0.01).血CRP、AOPP浓度随衰竭器官数增加而明显升高(P均<0.05),AOPP浓度与CRP呈高度正相关(r=0.448,P<0.01).结论 AOPP可能参与了MODS的发病过程,AOPP浓度异常增高反映MODS患者体内存在严重氧化应激状态,可作为判断MODS患者器官功能障碍程度和预后的重要指标.     

降钙素原对脓毒症患者病情及预后的临床价值

目的：探讨降钙素原（procalcitonin,PCT）对脓毒症患者病情及预后的临床价值,及其与急性生理学与慢性健康状况Ⅱ评分（APACHEⅡ评分）的相关性。方法回顾性分析2013年1月1日至2014年12月31日收住本院急诊科（包括普通病房及急诊重症监护室 EICU）、感染科的109例脓毒症患者的临床资料（包括入院24 h 内 PCT 值、白细胞计数 WBC 及中性粒细胞百分比Neut％、APACHEⅡ评分等）。据患者病情严重程度（脓毒血症组、严重脓毒症组和脓毒性休克组）、临床结局（存活组和死亡组）及多器官功能障碍综合征 MODS （MODS 组和非 MODS 组）不同进行分组,比较各组中各指标差异,分析 PCT 与 APACHEⅡ评分两者之间的相关性,评价 PCT、APACHEⅡ评分和 APACHEⅡ评分＋PCT 在评估患者预后及多器官功能障碍综合征中的价值,及分析 PCT 对脓毒症患者预后的独立效应及脓毒症患者预后的影响因素。结果脓毒血症组中 PCT 值、APACHEⅡ评分均低于严重脓毒症组和脓毒性休克组,严重脓毒症组均低于脓毒性休克组,三组之间差异均有统计学意义（P ＜0.05）。脓毒血症组中 WBC 明显低于脓毒性休克组（P ＜0.05）。死亡组较存活组中的 APACHEⅡ评分显著升高,差异有统计学意义（P ＜0.01）,而 PCT 值、WBC、Neut％在两组间则差异无统计学意义。非 MODS 组中 APACHEⅡ评分、WBC、Neut％、PCT 值均显著低于 MODS 组（均 P ＜0.05）。PCT 与 APACHEⅡ评分之间呈显著正相关关系（rs ＝0.403,P ＜0.01）。通过绘制 PCT、APACHEⅡ评分、APACHEⅡ评分＋PCT 三者的受试者工作曲线（ROC）来评估脓毒症患者预后情况,得出三者的 ROC 曲线下面积（AUC）分别为0.617、0.899、0.917,而APACHEⅡ评分、APACHE Ⅱ评分＋PCT 的预后评估价值均较 PCT 高（均 P ＜0.01）,且 PCT、APACHEⅡ评分的截断值（cut-off）、灵敏度、特异度分别为（3.40 ng／mL、88.24％、38.04％）和（20分、94.12％、81.52％）。同样 PCT、APACHEⅡ评分、APACHEⅡ评分＋PCT 三者评估脓毒症患者多器官功能障碍综合征的 AUC 分别为0.824、0.796、0.871,PCT 分别与 APACHEⅡ评分、APACHEⅡ评分＋PCT 间差异无统计学意义,且 PCT、APACHEⅡ评分的截断值、灵敏度、特异度分别为（7.26 ng／mL、88.24％、63.79％）和（17分、64.71％、87.93％）。PCT 对脓毒症患者预后的 COR、AOR 分别为1.008、1.014,性别与 APACHEⅡ评分是影响脓毒症患者预后的独立危险因素。结论 PCT 值、APACHEⅡ评分能评估脓毒症患者病情,三者间均呈正相关关系。APACHEⅡ评分、APACHEⅡ评分＋PCT 较 PCT 能更好评估患者预后,且 PCT 不能作为预后评估的独立指标;而 PCT、APACHEⅡ评分、APACHEⅡ评分＋PCT 对脓毒症患者多器官功能障碍综合征的评估效能均较好。PCT 研究需考虑混杂因素,性别与 APACHEⅡ评分是脓毒症患者预后的两个独立危险因素。     

Procalcitonin: a valuable indicator of infection in a medical ICU?

OBJECTIVE: To assess the use of procalcitonin (PCT) for the diagnosis of infection in a medical ICU. DESIGN: Prospective, observational study. PATIENTS: Seventy-seven infected patients and 24 patients with systemic inflammatory response syndrome (SIRS) due to other causes. Seventy-five patients could be classified into sepsis (n = 24), severe sepsis (n = 27) and septic shock (n = 24), and 20 SIRS patients remained free from infection during the study. Plasma PCT and C-reactive protein (CRP) levels were evaluated within 48 h of admission (day 0), at day 2 and day 4. RESULTS: As compared with SIRS, PCT and CRP levels at day 0 were higher in infected patients, regardless of the severity of sepsis (25.2 +/- 54.2 ng/ml vs 4.8 +/- 8.7 ng/ml; 159 +/- 92 mg/l vs 71 +/- 58 mg/l, respectively). At cut-off values of 2 ng/ml (PCT) and 100 mg/l (CRP), sensitivity and specificity were 65% and 70% (PCT), 74% and 74% (CRP). PCT and CRP levels were significantly more elevated in septic shock (38.5 +/- 59.1 ng/ml and 173 +/- 98 mg/l) than in SIRS (3.8 +/- 6.9 ng/ml and 70 +/- 48 mg/l), sepsis (1.3 +/- 2.7 ng/ml and 98 +/- 76 mg/l) and severe sepsis (9.1 +/- 18. 2 ng/ml and 145 +/- 70 mg/l) (all p = 0.005). CRP, but not PCT, levels were more elevated in severe sepsis than in SIRS (p<0.0001). Higher PCT levels in the patients with four dysfunctional organs and higher PCT and CRP levels in nonsurvivors may only reflect the marked inflammatory response to septic shock. CONCLUSION: In this study, PCT and CRP had poor sensitivity and specificity for the diagnosis of infection. PCT did not clearly discriminate SIRS from sepsis or severe sepsis.     

The clearance of Procalcitonin (PCT) during continuous veno-venous hemodiafiltration (CVVHD)

Objective. To evaluate the Procalcitonin (PCT) clearance during continuous veno-venous hemodiafiltration (CVVHD).?Design. Case report?Setting. Surgical intensive care unit?Patient. 51-year-old man, who had undergone total thyroidectomy about ten years before owing to multiple endocrine neoplasia 2 (MEN 2), suffering from multiple organ dysfunction syndrome (MODS) with acute renal failure after severe trauma caused by a traffic accident.?Measurements and main result. The samplings of prefilter (afferent) and post-filter (efferent) blood and of ultradiafiltrate were 6 times performed during 24 h of CVVHD to calculate the PCT clearance of hemdiafiltration.?During the first half period of CVVHD the serum PCT concentration did not decrease, though PCT had been eliminated from serum. On the other hand during the latter half period of it the serum PCT value decreased (from 46.8 ng/ml to 29.4 ng/ml) and the amount of the eliminated PCT from serum was about 100 ng per minute and its clearance was 2.3 ∼ 3.4 ml/min.?Conclusion. The CVVHD could eliminate PCT from serum. First it was brought about by the adsorption by the filter menbrane and then by ultradiafiltration. Received: 25 February 1999/Final revision received: 31 May 1999/Accepted: 9 June 1999     

高容量血液滤过并容量复苏对脓毒性休克血乳酸及炎症因子清除作用的研究

目的 探讨高容量血液滤过(HVHF)联合容量复苏对难治性脓毒性休克并多器官功能障碍综合征(MODS)患者动脉血乳酸、炎症细胞因子以及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭估计系统(SOFA)评分的影响.方法 89例难治性脓毒性休克并MODS患者随机分为容量复苏组(41例)和容量复苏并HVHF组(48例),比较两组患者治疗前后动脉血乳酸及乳酸清除率、白细胞介素-6(IL-6)、降钙素原(PCT)、高敏C-反应蛋白(hs-CRP)的水平以及APACHEⅡ评分、SOFA评分的变化.结果 ①两组治疗后动脉血乳酸清除率均逐渐升高;HVHF组治疗后6、12、24 h动脉血乳酸清除率[(18.8±10.3)%、(31.6±11.4)%、(39.2±16.4)%]明显高于容量复苏组[分别为(10.7±7.5)%、(14.7±10.3)%、(16.5±10.2)%,P＜0.05或P<0.01].②两组治疗后血清IL-6、PCT、hs-CRP水平均逐渐降低,HVHF组治疗1 d、3 d时均显著低于容量复苏组(P＜0.05或P<0.01).③两组治疗后APACHEⅡ评分、SOFA评分均逐渐降低,且治疗7 d时HVHF组显著低于容量复苏组(P＜0.05和P<0.01).结论 HVHF联合容量复苏能降低难治性脓毒性休克并MODS患者动脉血乳酸、炎症细胞因子水平及APACHEⅡ评分、SOFA评分,改善患者的预后.     

BJ—MODS、APACHEII、SOFA、Marshall—MODS评分系统对MODS患者病情评估价值的比较

目的评价BJ—MODS、APACHEII、SOFA、Marshall—MODS四种评分系统对多器官功能障碍综合征（MODS）患者的病情评估及预后的价值。方法前瞻性、多中心搜集MODS患者191例,选取资料完整的MODS患者141例,分别进行BJ—MODS、APACHEII、SOFA、Marshall—MODS评分,比较存活组和死亡组之间各种评分以及同一组不同时间段的分值差异;以及四种评分不同分数段患者病死率。然后分别绘制患者入组第1天的BJ—MODS、APACHEII、SOFA、Marshall—MODS受试者工作特征曲线,计算ROC曲线下面积,评价各评分预测MODS患者预后的准确性。结果141例患者中,存活84例（59．6％）,死亡44例（32．2％）,放弃治疗12例（8．5％）,其他1例（0．7％）。总住院病死率为31．2％,ICU病死率为29．1％。存活纽和死亡组在入组第1天APAcHEⅡ评分,有统计学差异（P〈0．05）,而BJ—MODS、SOFA、Marshall—MODS评分均无统计学差异（P〉0．05）,入组第7天的BJ—MODS、APACHEII、SOFA、Mar-shall—MODS评分均有统计学差异（P〈0．05）。存活组和死亡组四种评分在两个时间段的差值,有统计学意义（P〈O．05）。BJ—MODS和Marshall—MODS评分随着病死率增加而增加,入组第7天差异有统计学意义（P〈0．001）;A-PAcHEⅡ和SOFA入组第1天评分随着病死率增加而有所下降,入组第7天差异有统计学意义（P〈0．001）。BJ—MODS评分入组第1天、入组第7天及第1天与第7天差值的曲线下面积分别为0．600、0．865、0．835,APACHEⅡ评分为0．618、0．869、0．821,SOFA评分为0．556、0．872、0．893,Marshall—MODS评分为0．551、0．870、0．871。BJ—MODS入组第1天评分随着器官障碍数目的增加而增加,有统计学差异（P〈0．05）,而BJ—MODS入组第7天、APACHElI、SO-FA、Marshall—MODS评分增加不明显。ICU病死率随着器官障碍数目的增加而增加,有统计学差异（P〈0．05）。结论APACHElI评分对MODS患者病情严重程度的顸后评估能力最好,BJ—MODS与SOFA、Marshall评分相当。