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.     

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.     

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.     

Pancreatic stone protein as an early biomarker predicting mortality in a prospective cohort of patients with sepsis requiring ICU management

ABSTRACT: INTRODUCTION: Biomarkers, such as C-reactive protein [CRP] and procalcitonin [PCT], are insufficiently sensitive or specific to stratify patients with sepsis. We investigate the prognostic value of pancreatic stone protein/regenerating protein (PSP/reg) concentration in patients with severe infections. METHODS: PSP/reg, CRP, PCT, tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL1-β), IL-6 and IL-8 were prospectively measured in cohort of patients ≥ 18 years of age with severe sepsis or septic shock within 24 hours of admission in a medico-surgical intensive care unit (ICU) of a community and referral university hospital, and the ability to predict in-hospital mortality was determined. RESULTS: We evaluated 107 patients, 33 with severe sepsis and 74 with septic shock, with in-hospital mortality rates of 6% (2/33) and 25% (17/74), respectively. Plasma concentrations of PSP/reg (343.5 vs. 73.5 ng/ml, P < 0.001), PCT (39.3 vs. 12.0 ng/ml, P < 0.001), IL-8 (682 vs. 184 ng/ml, P < 0.001) and IL-6 (1955 vs. 544 pg/ml, P < 0.01) were significantly higher in patients with septic shock than with severe sepsis. Of note, median PSP/reg was 13.0 ng/ml (IQR: 4.8) in 20 severely burned patients without infection. The area under the ROC curve for PSP/reg (0.65 [95% CI: 0.51 to 0.80]) was higher than for CRP (0.44 [0.29 to 0.60]), PCT 0.46 [0.29 to 0.61]), IL-8 (0.61 [0.43 to 0.77]) or IL-6 (0.59 [0.44 to 0.75]) in predicting in-hospital mortality. In patients with septic shock, PSP/reg was the only biomarker associated with in-hospital mortality (P = 0.049). Risk of mortality increased continuously for each ascending quartile of PSP/reg. CONCLUSIONS: Measurement of PSP/reg concentration within 24 hours of ICU admission may predict in-hospital mortality in patients with septic shock, identifying patients who may benefit most from tailored ICU management.     

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。     

Multicenter prospective study of procalcitonin as an indicator of sepsis

The clinical significance of serum procalcitonin (PCT) for discriminating between bacterial infectious disease and nonbacterial infectious disease (such as systemic inflammatory response syndrome (SIRS)), was compared with the significance of endotoxin, β-D-glucan, interleukin (IL)-6, and C-reactive protein (CRP) in a multicenter prospective study. The concentrations of PCT in patients with systemic bacterial infection and those with localized bacterial infection were significantly higher than the concentrations in patients with nonbacterial infection or noninfectious diseases. In addition, PCT, endotoxin, IL-6, and CRP concentrations were significantly higher in patients with bacterial infectious disease than in those with nonbacterial infectious disease (P < 0.001, P < 0.005, P < 0.001, and P < 0.001, respectively). The cutoff value of PCT for the discrimination of bacterial and nonbacterial infectious diseases was determined to be 0.5 ng/ml, which was associated with a sensitivity of 64.4% and specificity of 86.0%. Areas under the receiver operating characteristic curves (POCs) were 0.84 for PCT, 0.60 for endotoxin, 0.77 for IL-6, and 0.78 for CRP in the combined group of patients with bacterial infectious disease and those with nonbacterial infectious disease, and the area under the ROC for PCT was significantly higher than that for endotoxin (P < 0.001). In patients diagnosed with bacteremia based on clinical findings, the positive rate of diagnosis with PCT was 70.2%, while that of blood culture was 42.6%. PCT is thus essential for discriminating bacterial infection from SIRS, and is superior in this respect to conventional serum markers and blood culture.     

The study on pro-adrenomedullin as a new biomarker in sepsis prognosis and risk stratification

OBJECTIVE: To assess the clinical value of pro-adrenomedullin (pro-ADM) in the prognosis and risk stratification in sepsis. METHODS: Fifty-one critically ill patients admitted to the intensive care unit (ICU) were prospectively stratified into four groups according to internationally recognized criteria: systemic inflammatory response syndrome (SIRS, 25 cases), sepsis (12 cases), severe sepsis (9 cases) and septic shock (5 cases). The levels of plasma pro-ADM was determined in every patient using a new sandwich immunoassay, and compared with procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and the acute physiology and chronic health evaluation II (APACHEII) score. RESULTS: (1) Median pro-ADM concentration was 0.34 mug/L for SIRS, 2.23 mug/L for sepsis, 4.57 mug/L for severe sepsis and 8.21 mug/L for septic shock. The plasma concentration of pro-ADM exhibited a gradual increase, and the median pro-ADM value was highest in the septic shock group (all P<0.05). (2) Compared with the other biomarkers, in the sepsis, severe sepsis and septic shock groups, the plasma concentration of pro-ADM and APACHEII score in the non-survivors was significantly higher than in the survivors (pro-ADM: 2.01 mug/L vs. 9.75 mug/L, APACHEII score: 23.44 scores vs. 38.21 scores, both P<0.05). (3) By the receiver operating characteristic (ROC) curve plot analysis of pro-ADM in sepsis, the area under the ROC curve for pro-ADM (0.87) in survivors was similar to the area under the ROC curve for PCT (0.81) and APACHEII score (0.81), and was significantly higher than the area under the ROC curve for CRP (0.53) and IL-6 (0.71). CONCLUSION: The measurement of pro-ADM is a new and useful marker in sepsis prognosis and risk strafification.     

血清降钙素原和D-二聚体检测在急诊脓毒症患者病情及预后评估中的应用价值

目的探讨血清降钙素原(PCT)和D-二聚体(D-D)检测在急诊脓毒症患者病情及预后评估中的应用价值。方法选取2017年1月至2018年4月首都医科大学附属北京友谊医院收治的脓毒症患者80例,回顾性分析患者的临床资料,根据病情严重程度将患者分为脓毒症组(n=35)、严重脓毒症组(n=25)、感染性休克组(n=20)。随访1年,根据患者治疗结局分为死亡组(n=24)与存活组(n=56),比较各组患者的血清PCT、D-D水平。结果感染性休克组患者的血清PCT[(17.97±1.84) ng/ml]、D-D [(5.13±0.58)mg/L]水平及死亡率(30.00%)显著高于脓毒症组患者的血清PCT [(3.47±1.06) ng/ml]、D-D[(1.60±0.34) mg/L]水平、死亡率(2.86%),差异具有统计学意义(P<0.05)。严重脓毒症组患者的血清PCT[(10.55±1.49) ng/ml]、D-D[(3.35±0.42)mg/L]水平及死亡率(20.00%)显著高于脓毒症组患者的血清PCT、D-D水平和死亡率(2.86%)差异具有统计学意义(P <0.05)。死亡组患者的血清PCT[(6.01±1.27) ng/ml]、D-D [(2.14±0.72) mg/L]水平显著高于存活组患者的血清PCT[(19.34±2.11) ng/ml]、D-D[(5.78±1.24) mg/L]水平差异具有统计学意义(P<0.05)。脓毒症患者治疗后的简易精神状态评价量表(MMSE量表)评分显著高于严重脓毒症和感染性休克组,急性生理与慢性健康评分(APACHEII)评分、序贯器官衰竭估计评分(SOFA)均显著低于严重脓毒症和感染性休克组,三组比较差异具有统计学意义(P<0.05)。结论检测血清PCT和D-D水平可有效评估急诊脓毒症患者的病情,并可有效预测患者的预后具有重要的临床意义。     

The utility of presepsin in diagnosis and risk stratification for the emergency patients with sepsis

Objectives

To evaluate the value of presepsin in diagnosis and risk stratification of septic patients in emergency department, and investigate the utility in differentiation of gram-positive and gram-negative bacterial infection.

Procalcitonin (PCT) is useful in predicting the bacterial origin of an acute circulatory failure in critically ill patients

Objective To evaluate the accuracy of procalcitonin (PCT) in predicting bacterial infection in ICU medical and surgical patients. Setting A 10-bed medical surgical unit. Design PCT, C-reactive protein (CRP), interleukin 6 (IL-6) dosages were sampled in four groups of patients: septic shock patients (SS group), shock without infection (NSS group), patients with systemic inflammatory response syndrome related to a proven bacterial infection (infect. group) and ICU patients without shock and without bacterial infection (control group). Results Sixty patients were studied (SS group:n=16, NSS group,n=18, infect. group,n=16, control group,n=10). The PCT level was higher in patients with proven bacterial infection (72±153 ng/ml vs 2.9±10 ng/ml,p=0.0003). In patients with shock, PCT was higher when bacterial infection was diagnosed (89 ng/ml±154 vs 4.6 ng/ml±12,p=0.0004). Moreover, PCT was correlated with severity (SAPS:p=0.00005, appearance of shock:p=0.0006) and outcome (dead: 71.3 g/ml, alive: 24.0 g/ml,p=0.006). CRP was correlated with bacterial infection (p<10⁻⁵) but neither with SAPS nor with day 28 mortality. IL-6 was correlated with neither infection nor day 28 mortality but was correlated with SAPS. Temperature and white blood cell count were unable to distinguish shocked patients with or without infection. Finally, when CRP and PCT levels were introduced simultaneously in a stepwise logistic regression model, PCT remained the unique marker of infection in patients with shock (PCT≥5 ng/ml, OR: 6.2, 95% CI: 1.1–37,p=0.04). Conclusion The increase of PCT is related to the appearance and severity of bacterial infection in ICU patients. Thus, PCT might be an interesting parameter for the diagnosis of bacterial infections in ICU patients.     

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。     

Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a, and interleukin-6

OBJECTIVE: To evaluate whether plasma concentrations of procalcitonin (PCT), interleukin-6 (IL-6), protein complement 3a (C3a), leukocyte elastase (elastase), and the C-reactive protein (CRP) determined directly after the clinical onset of sepsis or systemic inflammatory response syndrome (SIRS) discriminate between patients suffering from sepsis or SIRS and predict the outcome of these patients. DESIGN: Prospective study. SETTING: Medical intensive care unit at a university hospital. PATIENTS: Twenty-two patients with sepsis and 11 patients with SIRS. MEASUREMENTS AND MAIN RESULTS: The plasma concentrations of PCT, C3a, and IL-6 obtained < or =8 hrs after clinical onset of sepsis or SIRS but not those of elastase or CRP were significantly higher in septic patients (PCT: median, 16.8 ng/mL, range, 0.9-351.2 ng/mL, p = .003; C3a: median, 807 ng/mL, range, 422-4788 ng/mL, p < .001; IL-6: median, 382 pg/mL, range, 5-1004 pg/mL, p = .009, all Mann-Whitney rank sum test) compared with patients suffering from SIRS (PCT: median, 3.0 ng/mL, range, 0.7-29.5 ng/mL; C3a: median, 409 ng/mL, range, 279566 ng/mL; IL-6: median, 98 pg/mL, range, 23-586 pg/mL). The power of PCT, C3a, and IL-6 to discriminate between septic and SIRS patients was determined in a receiver operating characteristic analysis. C3a was the best variable to differentiate between both populations with a maximal sensitivity of 86% and a specificity of 80%. An even better discrimination (i.e., a maximal sensitivity of 91% and a specificity of 80%) was achieved when PCT and C3a were combined in a "sepsis score." C3a concentrations also helped to predict the outcome of patients. Based on the sepsis score, a logistic regression model was developed that allows a convenient and reliable determination of the probability of an individual patient to suffer from sepsis or SIRS. CONCLUSIONS: Our data show that the determination of PCT, IL-6, and C3a is more reliable to differentiate between septic and SIRS patients than the variables CRP and elastase, routinely used at the intensive care unit. The determination of PCT and C3a plasma concentrations appears to be helpful for an early assessment of septic and SIRS patients in intensive care.     

血清降钙素原在早期诊断脓毒症中的临床研究

目的 观察危重病人在脓毒症及全身性炎症反应综合征(SIRS)时血清降钙素原(PCT)水平的变化及临床意义。方法 38例入选患者分为脓毒症组和SIRS组,分别采用BRAHMS快速半定量法(PCT-Q)和免疫比浊法测定血清PCT、C-反应蛋白(CRP)浓度,同时比较两组间最高体温(BT)、白细胞计数(WBC计数)及中性粒细胞分类,评价PCT、CRP、WBC计数及中性粒细胞分类、BT在SIRS患者中对脓毒症的诊断价值。结果 RCT在脓毒症组较SIRS组显著升高(x±s分别是2.72±1.07分和1.55±0.76分,P=0.001),两组间CRP、WBC计数及中性粒细胞分类、BT比较无差异,对脓毒症的诊断价值由高到低分别为PCT、CRP、BT、中性粒细胞分类和白细胞计数(AUC分别是0.80、0.64、0.64、0.61、0.43)。结论 PCT可以作为早期诊断脓毒症的可靠指标,其他传统炎症指标在区分感染性与非感染性SIRS中的意义有限。     

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.     

Circulating complement (C3 and C4) for differentiation of SIRS from sepsis

The systemic inflammatory response of the body to invading microorganisms, called sepsis, leads to profound activation of the complement (C3 and C4) system. The present study was conducted to compare the use of serum C3 and C4 levels with C-reactive protein (CRP) and thrombocyte and leukocyte counts in differentiating patients with systemic inflammatory response syndrome (SIRS) from those with sepsis. Over a 6-mo period, all patients with SIRS or sepsis who stayed in the intensive care unit for > 24 h were enrolled in the study. At admission, each patient’s clinical status was recorded, and blood was taken for laboratory analysis (complete blood count, CRP, C3, and C4). A total of 58 patients with SIRS and 41 patients with sepsis were admitted to the study. The mean±SD thrombocyte count was found to be significantly lower in septic patients (179,975±95,615) than in those with SIRS (243,165±123,706) (P=.005); no difference in plasma concentrations of CRP and levels of C3 and C4 was noted between groups. The thrombocyte count was determined to be the most reliable parameter for differentiating between SIRS and sepsis (highest area under the curve=0.656).     

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.     

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。     

Derivation of a screen to identify severe sepsis and septic shock in the ED-BOMBARD vs. SIRS and qSOFA

Study objectiveTo predict severe sepsis/septic shock in ED patients.MethodsWe conducted a retrospective case-control study of patients ≥18 admitted to two urban hospitals with a combined ED census of 162,000.Study cases included patients with severe sepsis/septic shock admitted via the ED. Controls comprised admissions without severe sepsis/septic shock. Using multivariate logistic regression, a prediction rule was constructed. The model's AUROC was internally validated using 1000 bootstrap samples.Results143 study and 286 control patients were evaluated. Features predictive of severe sepsis/septic shock included: SBP ≤ 110 mm Hg, shock index/SI ≥ 0.86, abnormal mental status or GCS < 15, respirations ≥ 22, temperature ≥ 38C, assisted living facility residency, disabled immunity.Two points were assigned to SI and temperature with other features assigned one point (mnemonic: BOMBARD). BOMBARD was superior to SIRS criteria (AUROC 0.860 vs. 0.798, 0.062 difference, 95% CI 0.022–0.102) and qSOFA scores (0.860 vs. 0.742, 0.118 difference, 95% CI 0.081–0.155) at predicting severe sepsis/septic shock. A BOMBARD score ≥ 3 was more sensitive than SIRS ≥ 2 (74.8% vs. 49%, 25.9% difference, 95% CI 18.7–33.1) and qSOFA ≥ 2 (74.8% vs. 33.6%, 41.2% difference, 95% CI 33.2–49.3) at predicting severe sepsis/septic shock. A BOMBARD score ≥ 3 was superior to SIRS ≥ 2 (76% vs. 45%, 32% difference, 95% CI 10–50) and qSOFA ≥ 2 (76% vs. 29%, 47% difference, 95% CI 25–63) at predicting sepsis mortality.ConclusionBOMBARD was more accurate than SIRS and qSOFA at predicting severe sepsis/septic shock and sepsis mortality.     

前肾上腺髓质素作为脓毒症危险分层新标志物的探讨

目的 探讨前肾上腺髓质素(pro-ADM)在脓毒症预测和危险分层中的价值.方法 采用前瞻性分析方法将51例入住重症加强治疗病房的危重病患者按国际脓毒症标准分为全身炎症反应综合征(SIRS)组(25例)、脓毒症组(12例)、严重脓毒症组(9例)、脓毒性休克组(5例)4组.取静脉血,采用新型夹心免疫荧光测量法检测pro-ADM浓度,并与急性生理学与慢性健康状况评分系统I(APACHE I)评分及降钙素原(PCT)、C-反应蛋白(CRP)和白细胞介素-6(IL-6)水平相比较.结果 ①SIRS组、脓毒症组、严重脓毒症组、脓毒性休克组血浆pro-ADM浓度逐渐升高,分别为0.34、2.23、4.57和8.21 μg/L,其中以脓毒性休克组pro-ADM浓度最高(P均＜0.05);②在所有脓毒症患者中,与其他标志物相比,死亡患者的pro-ADM浓度比存活患者明显升高(2.01 μg/L比9.75 μg/L,P＜0.05),APACHE I评分也明显升高(23.44分比38.21分,P＜0.05);③在脓毒症存活患者的受试者工作特征曲线分析中,pro-ADM、PCT、APACHE I评分的曲线下面积(分别为0.87、0.81和0.81)较CRP和IL-6(分别为0.53和0.71)明显增多.结论 pro-ADM浓度测定在脓毒症的预测和危险分层中是一个新的有用的标志物.     

The Italian SEPSIS study: Preliminary results on the incidence and evolution of SIRS,sepsis, severe sepsis and septic shock

This prospective, multicenter, epidemiological study was carried out in 99 Italian ICUs, distributed throughout the country, from April 1993 to March 1994. In the study, we applied the new ACCP/SCCM classification system for sepsis (SIRS, sepsis, severe sepsis and septic shock) and determined the prevalence, incidence, evolution and outcome of these categories in critically ill patients. The preliminary analysis of 1101 patients showed that on admission SIRS accounted for about half of the diagnoses (52%) with sepsis, severe sepsis and septic shock accounting for 4.5%, 2.1% and 3% of patients, respectively. Patients with severe sepsis or septic shock more frequently had high SAPS scores than patients without sepsis. Mortality rates were similar in patients with SIRS (26.5%) and without SIRS or infection (24%), but rose to 36% in patients with sepsis, to 52% in those with severe sepsis and to 81.8% in those with septic shock. Sepsis, severe sepsis and septic shock were more common in patients with medical diagnoses, and neither severe sepsis nor septic shock was observed in trauma patients. With respect to evolution, the incidence of septic shock was progressively higher in patients admitted with more severe “sepsis-related” diagnoses, while only a trivial difference in rates of incidence was observed between SIRS patients and those admitted without SIRS or any septic disorder (nil). The breakdown of the various ACCP/SCCM “sepsis-related” diagnoses at any time during the study was: SIRS in 58% of the population, sepsis in 16.3%, severe sepsis in 5.5% and septic shock in 6.1%. It seems reasonable to expect from the final evaluation of our study answers to the questions raised by the ACCP/SCCM Consensus Conference about the correlations between “sepsis-related” diagnosis, severity score, organ dysfunction score and outcome.