Objective To explore the clinical significances of serum procalcitonin ( PCT) and Creactive protein( CRP) in diagnosis and severity assessment of sepsis. Methods A total of 72 patients with different severities of sepsis admitted to Wenzhou Second People’s Hospital from June 2005 to September 2007, including 22 cases of sepsis, 26 cases of severe sepsis, and 24 cases of sepsis shock. Meanwhile, twenty non-sepsis patients were enrolled as control group. The differences of serum PCT and CRP levels, acute physiology and chronic health evaluation Ⅱ ( APACHEⅡ) scores and sepsis related organ failure assessment ( SOFA) scores were compared in controls and the septic patients with different severities and different prognosis. Results The PCT levels of patients with sepsis, severe sepsis and sepsis shock were significantly higher than that in the non-sepsis group [ ( 1. 51 ±1. 57) , ( 5. 62 ±3. 78) and ( 13. 56 ±8. 16) vs ( 0. 12 ± 0. 33) μg/L, P lt;0. 05 or P lt; 0. 01, respectively] . The CRP level, APACHEⅡ and SOFA were also increased in septic patients compared to control and progressively elavated by the severities of sepsis patients ( P lt; 0. 05 or P lt; 0. 01) , however, CRP levels were not significant different ( P gt; 0. 05) . The PCT levels, APACHEⅡ and SOFA of the patients with good prognosis were lower than those with poor prognosis( all P lt; 0. 01) , but the CRP levels was not significant different( P gt;0. 05) . Conclusion The serumlevel of PCT is superior to serumlevel of CRP in severity classification and prognosis assessment.
Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.
Objective To investigate the expression and clinical significance of soluble triggering receptor expression on myeloid cells-1（sTREM-1） in sepsis patients.Methods Serum concentrations of sTREM-1，procalcitonin（PCT），tumor necrosis factor alpha（TNF-α） and interleukin-10（IL-10） were measured by enzyme-linked immunosorbent assay，while high sensitivity C-reactive protein （hsCRP） level was detected by immunoturbidimetry in 68 patients with sepsis，40 patients with no-infective SIRS，and 20 normal individuals. The diagnostic and prognostic value of sTREM-1 and its comparison with PCT and hsCRP were analyzed. The sequential organ failure assessment （SOFA） score system was used to evaluate the severity of sepsis. The relationship between sTREM-1, PCT , hsCRP , SOFA score，TNF-α ,and IL-10 of the sepsis patients was analyzed，respectively. Results The differences in the serum concentrations of sTREM-1，PCT，hsCRP，IL-10 and IL-10/TNF-α ratio had statistical significance among three groups（Plt;0.05）. The differences in the serum concentration of TNF-α had no statistical significance among three groups （Pgt;0.05）. However，the serum levels of sTREM-1，PCT and hsCRP in the sepsis group were significantly higher than those in the SIRS group （Plt;0.05）. The receiver operating characteristic curve （ROC） analysis showed the area under the curve （AUC） for sTREM-1，PCT and hsCRP were 0.772 （95%CI 0.674-0.871），0.718 （95%CI 0.601-0.835） and 0.664 （95%CI 0.532-0.797），respectively. The serum levels of sTREM-1 and PCT in the non-survivors were significantly higher than the survivors in the sepsis group （Plt;0.01），but the differences in the serum concentration of hsCRP had no statistical significance between the non-survivors and the survivors in the sepsis group （Pgt;0.05）. There were significantly positive correlations between sTREM-1 and SOFA score，IL-10 or IL-10/TNF-α ratio（r value of 0.453，0.301，0.417，Plt;0.05），but no correlation between sTREM-1 and TNF-α（Pgt;0.05）. There was significantly positive correlation between PCT and SOFA score （r=0.436，Plt;0.05），while no relationship between hsCRP and SOFA score（Pgt;0.05）. Conclusions The serum level of sTREM-1 not only be valuable in the diagnosis of sepsis，but also may be used as a prognostic marker in sepsis，as it can reflect the severity of sepsis in certain degree. Furthermore，sTREM-1 or PCT may be superior to hsCRP in diagnosis，prognostic judgment and severity assessment of sepsis.
Objective To investigate the value of procalcitonin-guided treatment on antibiotic use in severe acute exacerbations of asthma. Methods From April 2008 to December 2010, a total of 77 patients with severe acute exacerbations of asthma were randomly assigned into a PCT group ( n =38) and a control group ( n=39) . The serum concentration of procalcitonin ( PCT) were measured in all patients. On the base of similar routine treatment, the control group received antibiotics based on the physician’s decision.Meanwhile the PCT group were treated with antibiotics according to serum PCT levels: antibiotic treatment was applied with PCT level ≥0. 25ng/mL and was discontinoued with PCT level lt; 0. 25ng/mL. Length of hospitalization, duration of antibiotics, cost of antibiotics, clinical efficacy were observed. Results The duration of antibiotics use in the PCT group [ 7 ( 5 ～11) d] was shorter than that in the control group [ 11( 7 ～16) d] ( Z = - 2. 26, P = 0. 025) , and the cost of antibiotics in the PCT group [ 2125( 1560 ～4347) yuan] was lower than that in the control group [ 3588 ( 2677 ～5280) yuan] ( Z = - 2. 01, P =0. 033) . The clinical efficacy and length of hospitalization were similar in two groups ( P gt; 0. 05) .Conclusion PCT guidance can reduce antibiotic duration and antibiotic cost in treatment of acute severe exacerbations of asthma.
Objective To evaluate the diagnostic accuracy of procalcitonin (PCT) for ventilator-associated pneumonia (VAP). Methods We searched MEDLINE, EMbase, The Cochrane Library, CBM, BIOSIS to identify all diagnostic tests which evaluated the diagnostic value of PCT in patients with VAP. QUADAS items were used to evaluate the quality of the included studies. Pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), summary receiver operating characteristic (SROC) curve, and the heterogeneity of the included studies were calculated by using the Meta-disk software. Results Five studies which were identified from 103 references met the inclusion criteria. The summary sensitivity, specificity, +LR, and –LR values were 0.70 (95%CI 0.62 to 0.77), 0.76 (95%CI 0.69 to 0.82), 5.651 (95%CI 1.237 to 25.810), and 0.349 (95%CI 0.155 to 0.784), respectively. Overall area under the curve (AUC) of SROC curve was 0.884 (DOR=19.416, 95%CI 2.473 to 152.47), demonstrating significant heterogeneity (I2gt;50%). Conclusion The use of PCT for VAP diagnosis has only a moderate sensitivity and specificity. Although the overall accuracy of VAP diagnosis is relatively high, there is significant heterogeneity between the studies, so more high-quality studies are needed. Besides, using PCT alone to diagnose VAP is not sufficient, and a combination with other clinical evaluations is necessary.
Objective To evaluate the value of serumprocalcitonin( PCT) guided antibiotic strategy in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) .Methods From August 2011 to June 2012, a total of 96 patients hospitalized for AECOPD were randomly assigned into a PCT-guided group( n = 48) and an empirical therapy group( n = 48) . The PCT levels of PCT-guided group were measured by immunochemiluminometric assays before and 5,7, 10 days after treatment. The PCT-guided group was treated with antibiotics according to serum PCT levels, ie. antibiotic treatment was applied when PCT level ≥ 0. 25 μg/L and was discouraged when PCT level lt; 0. 25 μg/L. The empirical therapy group received antibiotics according to physician’s decision. The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, clinical efficacy, hospital mortality, rate of invasive mechanical ventilation and costs of hospitalization were recorded. Results The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, and costs of hospitalization in the PCT-guided group were all lower than those of the empirical therapy group( P lt;0.05) while clinical efficacy, hospital mortality and rate of invasive mechanical ventilation were similar in two groups(Pgt;0.05) . Conclusion PCT guided antibiotic strategy can be used in the treatment of AECOPD, which may reduce the dose of antibiotic drugs to avoid bacterial resistance and lower costs of hospitalization.
Objective To assess the value of procalcitonin ( PCT) in serum and percentage of infected cells ( PIC) in bronchoalveolar lavage fluid ( BALF) for the diagnosis of early ventilator-associatedpneumonia ( VAP) .Methods A prospective observational study was conducted in a teaching hospital. The patients consecutively admitted to the intensive care unit from January 2011 to June 2012, who received mechanical ventilation for more than 48h and clinically suspected for VAP, were recruited in the study.Patients with infection outside the lungs and previous diagnosed infection were excluded. PCT was detected and bronchoalveolar lavage was performed in the day when VAP was diagnosed. BALF cells were stained by May-Grunwald Giemsa ( MGG) for counting 100 phagocytic cells and calculating infected cells ( ICs )percentage.Results 76 of all 421 patients were enrolled in this study, 64 of which were diagnosed, 12 were under-diagnosed. The PCT [ ( 3. 48 ±1. 46) ng/mL vs. ( 1. 53 ±0. 60) ng/mL] and PIC [ ( 3. 11 ±1. 47) % vs. ( 1. 08 ±0. 29) % ] were significant higher in the patients with VAP. The threshold of 2 ng/mL of PCT and 2% of PIC corresponded to sensitivity of 78. 12% and 78. 12% , and specificity of 75. 00% and 91. 67% , respectively. The area under the receiver operating characteristic ( ROC) curve was 0. 87 ( 95% CI 78. 9%-95. 9% ) and 0. 874 ( 95% CI 79. 2% -94. 9% ) , respectively. The area under ROC curve was 0. 979, and the sensitivity was 97. 36% , specificity was 97. 36% when the two cutoff values were both achieved. Conclusion PCT and PIC are useful markers to diagnose early VAP quickly and conveniently and allow early antibiotic treatment of patients with suspected VAP.
Objective To investigate the values of pneumonia severity index ( PSI) , CURB-65,plasma procalcitonin ( PCT) , C-reactive protein ( CRP) measurements for evaluation the severity of healthcare-associated pneumonia ( HCAP) .Methods A retrospective observational study was conducted on 92 hospitalized patients with HCAP admitted between June 2010 and December 2011. They were divided into different groups according to different severity assessment criteria. The variance and correlation of PCT,CRP,WBC and percent of neutrophil ( Neu% ) levels were compared among different groups. ROC curvewas established to analyze PSI, CURB-65, PCT and CRP levels for predicting the motality of HCAP patients.Results In the severe HCAP group, PSI and CURB-65 scoring and serum PCT, CRP, WBC, Neu% levels were significantly higher than those in the non-severe HCAP group( P lt; 0. 05) . In the high-risk HCAP group, PCT, CRP, WBC and Neu% levels were significantly higher than those in the low-risk HCAP group according to the PSI and CURB-65 scoring criteria( P lt;0. 05) .WBC and Neu% levels were also significantly higher than those in the moderate-risk group. PSI and CURB-65 scoring were positively correlated with PCT and CRP levels. PSI scoring gt;120 points or CURB-65 scoring gt;2 points on admission were predictors of mortality. Conclusions PSI and CURB-65 scoring are correlated with severity of HCAP. Combining serum PCT and CRP levels can improve the predictive accuracy of the severity of HCAP.
ObjectiveTo explore procalcitonin (PCT) dynamically in severe community-acquired pneumonia (SCAP) patients to evaluate the effects of different kinds of medical treatments and assess the clinical significance of the change of PCT. MethodsAll of the selected 60 SCAP patients treated from January 2009 to April 2011 met the standards of IDSA/ATS Guidelines for CAP. There were 38 males and 22 females, with an average age of 66.3 years. The sterile venous blood specimen samples were collected from the patients at day 0 to day 5. PCT and C-reactive protein (CRP) were measured by enzyme linked immunosorbent assay throughout the research. At day six, based on oxygenation index (PaO2/FiO2) ratio higher than 250, inflammation absorption on chest X ray after vasoactive agents were stopped, Glasgow scores higher than 10 and urine volume equal to or higher than 0.5 mL/(kg·d), we divided the patients into recovery group and deterioration group. Data were analyzed by SAS 9.0 software, and P<0.05 was considered to be statistically significant. ResultsThe analysis results showed that PCT and CRP bore a significantly positive relationship on day 0 (r=0.38, P=0.00). The research also indicated that PCT had a faster declining rate than CRP and white blood cells count throughout the clinical treatment. The average of PCT declined 29% in 48 hours. Following the criterion of PCT decrease by 30%, the research showed that PCT had a higher sensibility and specificity (66.87% and 85.50%, respectively) in 48 hours than 72 hours (70.05% and 100.00%), 96 hours (79.88% and 75.23%), and 120 hours (83.10% and 100.00%). ConclusionFollowing the criterion of PCT decrease by 30% after using antibiotics can be an clinical objective index to guide the use of antibiotics and provide the basis for clinical application and prognosis.
ObjectiveTo examine and compare the value of procalcitonin (PCT), C-reactive protein (CRP) and interleukin (IL)-6 in diagnosing fetal sepsis in premature neonates. MethodsPreterm neonates with premature rupture of membrane between January 2010 and September 2012 were screened, and the serum levels of PCT, CRP and IL-6 were detected in the first day of life. All preterm neonates were divided into two groups according to the development of sepsis (45 cases with sepsis and 39 cases without sepsis). ResultsThe levels of PCT, CRP and IL-6 in premature neonates with sepsis were all significantly higher than those without sepsis. The cut-off value of PCT in diagnosis of sepsis was 2.14 μg/L, with a sensitivity and specificity of 76% and 85% respectively; the cut-off value of CRP in diagnosis of sepsis was 7.90 mg/L, with a sensitivity and specificity of 67% and 61% respectively. For IL-6, the cut-off value in diagnosis of sepsis was 13.80 ng/L, and its sensitivity and specificity were high to 90% and 94%, respectively. ConclusionIL-6 is the most reliable biochemical marker for the detection of early-onset sepsis in preterm neonates with premature rupture of membrane.