균혈증의 조기 발견을 위한 Procalcitonin/Albumin Ratio와 Blood Urea Nitrogen/Albumin Ratio의 임상적 유용성
Clinical usefulness of procalcitonin/albumin and blood urea nitrogen/albumin ratios for the early detection of bacteremia
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배경: 적절한 시기에 균혈증을 치료하지 않으면 패혈증이 발생할 수 있으므로 균혈증의 조기 예측이 중요하다. 우리는 혈액 검사가 그람 음성 균혈증과 그람 양성 균혈증을 예측하는 데 임상적으로 유용한지 알아보고자 했다. 방법: 2018년 1월 1일부터 2018년 12월 31일까지 가톨릭대학교 의정부성모병원에 내원한 환자 중혈액 배양 검사를 받은 환자 16,569명의 의무기록을 후향적으로 분석하였다. 분석에 필요한 데이터가 불충분한 15,580명의 환자를 제외한 후 총 연구 대상자는 989명이었다. 결과: 주요 변수들을 보정한 후 그람 음성 균혈증에 대해 분석한 다변수 로지스틱 회귀분석에서 procalcitonin (odds ratio [OR] 1.02, P < 0.001), high-sensitivity C-reactive protein (OR 1.03, P = 0.010),albumin (OR 0.55, P = 0.010)이 통계적으로 유의하였다. 같은 모델에서 lactic acid (OR 1.08, P = 0.010),blood urea nitrogen (BUN) (OR 1.02, P = 0.010), albumin (OR 0.50, P = 0.005)은 그람 양성 균혈증에 대해 통계적 유의하였다. 우리는 다변수 로지스틱 회귀분석에서 유의하였던 혈액 검사들을 조합하여 혈액 지표들을 만들었다. 수신기 작동 특성 곡선(receiver operating characteristic curve)의 곡선하면적(area under the curve, AUC)을 비교한 결과, 그람 음성 균혈증에서 procalcitonin/albumin ratio의AUC는 procalcitonin의 AUC보다 유의하게 높았고(0.846 vs. 0.837, P = 0.005), 그람 양성 균혈증에서BUN/albumin ratio의 AUC는 BUN의 AUC보다 유의하게 높았다(0.709 vs. 0.679, P = 0.007). 결론: 그람 음성 균혈증의 조기 예측에 procalcitonin/albumin ratio가, 그리고 그람 양성 균혈증의 조기 예측에 BUN/albumin ratio가 도움을 줄 것으로 생각된다.
Abstract
Background: Early prediction of bacteremia is important because sepsis may develop ifbacteremia is not treated in time. We aimed to determine whether blood tests are clinicallyuseful in predicting gram-negative versus gram-positive bacteremia. Methods: We retrospectively analyzed the medical records of 16,569 patients who underwentblood culture testing among those who visited St. Mary’s Hospital of Uijeongbu, CatholicUniversity from January 1, 2018 to December 31, 2018. After excluding 15,580 patients withinsufficient data for analysis, the total study population was 989. Results: In the multivariable logistic regression analysis for gram-negative bacteremia, afteradjusting for major variables, procalcitonin (odds ratio [OR] 1.02, P < 0.001), high-sensitivityC-reactive protein (OR 1.03, P = 0.010), and albumin (OR 0.55, P = 0.010) were significant. Inthe same model, lactic acid (OR 1.08, P = 0.010), blood urea nitrogen (BUN) (OR 1.02, P =0.010), and albumin (OR 0.50, P = 0.005) were significant for gram-positive bacteremia. We constructed blood indicators by combining blood tests that were significant inmultivariable logistic regression analysis. Comparing the area under the curve (AUC) of thereceiver operating characteristic curve, the AUC of the procalcitonin/albumin ratio in gramnegativebacteremia was significantly higher than that of procalcitonin (0.846 vs. 0.837, P =0.005), and the AUC of the BUN/albumin ratio in gram-positive bacteremia was significantlyhigher than that of BUN (0.709 vs. 0.679, P = 0.007). Conclusion: The procalcitonin/albumin ratio is expected to be helpful in the early predictionof gram-negative bacteremia, whereas the BUN/albumin ratio in the early prediction of grampositivebacteremia.
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