Assessment of Diagnostic Value of Procalcitonin and/or (1,3)-β-D-glucan Test for Pulmonary Infection_West China Medical Journal

Authors：

 LUXian-lei ¹ , LUOYu-peng ¹ , CAOZhi-yue ¹ , YANGJin ¹ , ZHUWen-lei ¹ , WANGPing ² , LIUBo ³ , ZHUYong ⁴

1. Clinical Laboratory, the Fifth People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;
2. Intensive Care Unit, the Fifth People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;
3. Department of Respiratory Medicine, the Fifth People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;
4. Department of Rheumatism and Hematology;the Fifth People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;

Corresponding author：

Keywords：

Procalcitonin; (1,3)-β-D-glucan; Pulmonary; Infection

DOI：

10.7507/1002-0179.20150069

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Objective To assess the diagnostic value of procalcitonin (PCT) and/or (1,3)-β-D-glucan test (serum BG assay) for pulmonary infection. Methods We collected 1 027 cases randomly from January 24th, 2013 to January 25th, 2014. First, we accumulated isolates from these cases in sputum culture. Second, we compared PCT and sputum culture, serum BG assay and sputum culture, CT and serum BG assay. Then we accumulated these PCT and studied its distribution when PCT>0.5 ng/mL and when their sputum culture was positive. We also accumulated these serum BG assay results and studied its distribution when their sputum culture was positive for aspergillus or suggested aspergillus infection by CT. Finally, we estimated the significance of the combined use of PCT and serum BG assay for diagnosis of pulmonary infection. Results In these cases, pathogens were mainly multiple drug-resistant organisms and tuberculosis, or fungi. We found that PCT value presented a skew distribution in disease with a median of 2.06 ng/mL. Single PCT or combination of PCT and sputum culture had similar distribution. With sputum culture as the reference, PCT sensitivity was 41.2% and specificity was 66.4%. In the cases of sputum culture aspergillus and CT suggestion of aspergillus infection, serum BG assay value distribution was similar, and the median and average were both lower than cut-off. With sputum culture as the reference, serum BG assay sensitivity was 13.2% and specificity was 84.1%. In the 12 cases with positive sputum culture and serum BG assay, serum BG assay median was 112.91 pg/mL. With CT as the reference, serum BG assay sensitivity was 21.4% and specificity was 75.0%. In the 17 cases with the same sputum and blood culture result with the PCT median of 7.51 pg/mL, there were three cases whose PCT value was under the cutoff and three cases whose serum BG assay value was above the cutoff. In evaluation of the combination of PCT and serum BG assay, the analysis had yielded that we could neither diagnose pulmonary infection with both being positive, nor exclude the disease with both being negative. Conclusion With regard to PCT and serum BG assay, we should be prudent and wise and use it after reasonable evaluation and entire analysis.

Citation： LUXian-lei, LUOYu-peng, CAOZhi-yue, YANGJin, ZHUWen-lei, WANGPing, LIUBo, ZHUYong. Assessment of Diagnostic Value of Procalcitonin and/or (1,3)-β-D-glucan Test for Pulmonary Infection. West China Medical Journal, 2015, 30(2): 222-226. doi: 10.7507/1002-0179.20150069 Copy

1.	Christ-Crain M, Jaccard-Stolz D, Bingisser R. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blinded interventiontrial[J]. Lancet, 2004, 363(9409):600-607.
2.	常春. 降钙素原在呼吸系统疾病中的应用[J]. 中华现代内科学杂志, 2006, 3(6):656-658.
3.	谢永平, 黎国梅, 温杰冉等. 血浆(1, 3)-β-D葡聚糖检测在肺部真菌感染疗效评价中的作用[J]. 国际检验医学杂志, 2014, 35(5):517-518.
4.	Onishi A, Sugiyama D, Kogata Y. Diagnostic accuracy of serum 1,3-β-D-Glucan for pneumocystis jiroveci pneumonia, invasive candidiasis, and invasive aspergillosis:systematic review and meta-analysis[J]. J Clin Microbiol, 2012, 50(1):7-15.
5.	汪明明, 崔速南, 张景遥, 等. 血清降钙素原测定在感染性疾病中的诊断意义[J]. 中国抗感染化疗杂志, 2002, 2(4):215-217.
6.	高航, 王君兰, 钱翠, 等. 血浆(1, 3)-β-D葡聚糖检测对慢性阻塞性肺疾病并发肺部真菌感染的研究[J]. 中华医院感染学杂志, 2012, 22(21):4690-4692.
7.	谢永平, 黎国梅, 温杰冉, 等. 血浆(1,3)-β-D葡聚糖检测在肺部真菌感染疗效评价中的作用[J]. 国际检验医学杂志, 2014, 35(5):517-518.
8.	中国侵袭性真菌感染工作组. 血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(第三次修订)[J]. 中华内科学杂志, 2010, 49(5):451-454.
9.	高蕾, 周新. (1, 3)-β-D 葡聚糖检测在侵袭性真菌感染中的诊断意义[J]. 中国感染与化疗杂志, 2008, 8(2):123-125.
10.	Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis[J]. Mater Sociomed, 2013, 25(4):277-281.
11.	杨兰萍, 胡皖玲, 余小龙. 血清降钙素原指导儿童呼吸道感染抗生素应用的临床意义[J]. 中国医学工程, 2014, 22(1):40-42.
12.	常秀娟, 王春平, 曾珍, 等. 血清降钙素原水平对发热患者的诊断价值研究[J]. 人民军医, 2014, 57(3):281-282.
13.	张志华, 潘航, 沈红石, 等. 降钙素原和超敏C反应蛋白检测在再生障碍性贫血合并肺部感染患者病原菌诊断中的意义[J]. 国际检验医学杂志, 2013, 34(23):3146-3148.
14.	梅春霞, 刘娟, 徐智. APACHEⅡ评分和降钙素原对肺部感染预后的预测作用[J]. 第三军医大学学报, 2014, 36(8):802-805.
15.	Dou YH, Du JK, Liu HL, et al. The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis[J]. Diagn Microbiol Infect Dis, 2013, 76(4):464-469.

1. Christ-Crain M, Jaccard-Stolz D, Bingisser R. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blinded interventiontrial[J]. Lancet, 2004, 363(9409):600-607.
2. 常春. 降钙素原在呼吸系统疾病中的应用[J]. 中华现代内科学杂志, 2006, 3(6):656-658.
3. 谢永平, 黎国梅, 温杰冉等. 血浆(1, 3)-β-D葡聚糖检测在肺部真菌感染疗效评价中的作用[J]. 国际检验医学杂志, 2014, 35(5):517-518.
4. Onishi A, Sugiyama D, Kogata Y. Diagnostic accuracy of serum 1,3-β-D-Glucan for pneumocystis jiroveci pneumonia, invasive candidiasis, and invasive aspergillosis:systematic review and meta-analysis[J]. J Clin Microbiol, 2012, 50(1):7-15.
5. 汪明明, 崔速南, 张景遥, 等. 血清降钙素原测定在感染性疾病中的诊断意义[J]. 中国抗感染化疗杂志, 2002, 2(4):215-217.
6. 高航, 王君兰, 钱翠, 等. 血浆(1, 3)-β-D葡聚糖检测对慢性阻塞性肺疾病并发肺部真菌感染的研究[J]. 中华医院感染学杂志, 2012, 22(21):4690-4692.
7. 谢永平, 黎国梅, 温杰冉, 等. 血浆(1,3)-β-D葡聚糖检测在肺部真菌感染疗效评价中的作用[J]. 国际检验医学杂志, 2014, 35(5):517-518.
8. 中国侵袭性真菌感染工作组. 血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(第三次修订)[J]. 中华内科学杂志, 2010, 49(5):451-454.
9. 高蕾, 周新. (1, 3)-β-D 葡聚糖检测在侵袭性真菌感染中的诊断意义[J]. 中国感染与化疗杂志, 2008, 8(2):123-125.
10. Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis[J]. Mater Sociomed, 2013, 25(4):277-281.
11. 杨兰萍, 胡皖玲, 余小龙. 血清降钙素原指导儿童呼吸道感染抗生素应用的临床意义[J]. 中国医学工程, 2014, 22(1):40-42.
12. 常秀娟, 王春平, 曾珍, 等. 血清降钙素原水平对发热患者的诊断价值研究[J]. 人民军医, 2014, 57(3):281-282.
13. 张志华, 潘航, 沈红石, 等. 降钙素原和超敏C反应蛋白检测在再生障碍性贫血合并肺部感染患者病原菌诊断中的意义[J]. 国际检验医学杂志, 2013, 34(23):3146-3148.
14. 梅春霞, 刘娟, 徐智. APACHEⅡ评分和降钙素原对肺部感染预后的预测作用[J]. 第三军医大学学报, 2014, 36(8):802-805.
15. Dou YH, Du JK, Liu HL, et al. The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis[J]. Diagn Microbiol Infect Dis, 2013, 76(4):464-469.

West China Medical Journal

Assessment of Diagnostic Value of Procalcitonin and/or (1,3)-β-D-glucan Test for Pulmonary Infection

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