血清降钙素原在老年尿路感染患者中的应用

目的探讨血清降钙素原(PCT)在老年尿路感染(UTI)患者中的临床应用价值。方法回顾性分析2013年1月—2014年12月某院感染内科114例老年UTI患者,比较血清降钙素原(PCT)异常和正常组患者临床资料,比较血培养阳性和阴性组患者PCT水平,绘制PCT诊断菌血症的受试者工作特征(ROC)曲线。结果 114例老年UTI患者,PCT异常组46例,PCT正常组68例。PCT异常组入院24 h内最高体温、血白细胞计数、中性粒细胞百分比、C反应蛋白(CRP)、血尿素氮(BUN)和肌酐(Cr)以及伴尿路梗阻疾病比例均高于PCT正常组患者(均P0.05)。42例血培养患者中,阳性组(12例)患者PCT水平为1.93(0.57~8.32)μg/L,高于血培养阴性组(30例)的0.36(0.15~1.01)μg/L(P=0.028)。PCT诊断合并菌血症者ROC曲线下面积(AUC)为0.72(95%CI:0.54~0.90),在最佳工作位点0.52μg/L时,敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)分别为83.3%、63.3%、47.6%和90.5%。结论血清PCT水平可以较好地反映老年UTI患者的病情,对于早期诊断老年UTI患者合并菌血症具有重要的参考价值。

Application of serum procalcitonin in urinary tract infection in elderly patients

ObjectiveTo investigate the clinical value of serum procalcitonin (PCT) in diagnosis of urinary tract infection(UTI) in elderly patients.Methods114 elderly patients with UTI in the department of infectious diseases of a hospital from January 2013 to December 2014 were analyzed retrospectively, clinical data of patients with abnormal and normal serum PCT were compared, PCT levels in patients with positive and negative blood cultures were compared, PCT receiver operating characteristic (ROC) curve for the diagnosis of bacteremia were drawn.ResultsAmong 114 elderly patients with UTI, 46 were with abnormal PCT, 68 were with normal PCT. In abnormal PCT group, the proportions of patients with highest body temperature within 24 hours of admission, white blood cell count, neutrophil granulocyte percentage, C reactive protein (CRP), blood urea nitrogen（BUN）, creatinine(Cr), and urinary tract obstructive disease were all higher than those with normal PCT (all P<0.05). Among 42 patients with blood culture, PCT level in positive blood culture group(n=12) was higher than negative blood culture group(n=30)(1.93 ［0.57-8.32］ μg/L vs 0.36［0.15-1.01］μg/L, P=0.028）. The area under the ROC curve (AUC) of the patients with bacteremia diagnosed by PCT was 0.72（95%CI：0.54-0.90），at the optimal value of 0.52 g/L, sensitivity, specificity, positive predictive value, and negative predictive value were 83.3%, 63.3%, 47.6%, and 90.5% respectively.ConclusionSerum PCT level can well reflect the severity of elderly patients with UTI, and is of great value in early diagnosis of bacteremia in elderly patients with UTI