균혈증에서 오염균과 병인균의 감별을 위한 Procalcitonin의 농도 값
The Value of Serum Procalcitonin Level for Differentiation between Contaminants and Pathogens in Bacteremia
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초록
배경: 균혈증은 생명을 위협하는 위중한 감염으로서 조기 진단과 이에 따른 적절한 항균제 치료에 의해 예후가 달라진다. 본 연구에서는 균혈증에서 오염균과 병인균의 감별 진단에서 혈청 procalcitonin (PCT)의 진단적 유용성을 평가해 보고자 하였다. 방법: 2008년 2월부터 10월까지 473명을 대상으로 혈청 PCT, C-reactive protein (CRP)과 혈액배양을 시행하였고, 의무기록을 토대로 임상 소견과 검사 결과를 후향적으로 분석하였다. 결과: 혈액배양 음성군과 양성군의 PCT 농도의 평균은 각각 6.45 ng/mL와 28.77 ng/mL로서 통계적으로 유의한 차이가 있었다(P＜0.001). PCT 농도는 그람음성막대균(평균±표준편차; 59.58±67.00 ng/mL) 균혈증에서 그람양성알균(평균±표준편차; 17.75±42.88 ng/mL) 균혈증에 비해 월등히 높았다(P＜0.001). 상대수행능곡선 분석에서 균혈증의 병인균에 대한 PCT와 CRP의 곡선아래면적(95% 신뢰구간)은 각각 0.880 (0.820∼0.940)과 0.637 (0.538∼0.736)였다. PCT 농도값 2 ng/mL를 판정기준치로 하면 병인균의 양성예측도와 음성예측도는 각각 83.6%와 77.4%였다. 결론: 혈청 PCT는 혈액배양에서 오염균과 병인균을 신속하고 정확하게 감별하는 데 도움을 줄 수 있는 유용한 검사였다.
Abstract
Background: Bacteremia is a life-threatening infection, and prognosis is highly dependent on early recognition and treatment with appropriate antimicrobial agents. We investigated the diagnostic performance of serum procalcitonin (PCT) for differentiation between contaminants and true pathogens in blood cultures. Methods: Serum PCT, C-reactive protein (CRP) and blood culture were performed for 473 patients between February 2008 and October 2008. We retrospectively reviewed the patients' clinical characteristics and laboratory results based on medical records. Results: The mean concentration of PCT was significantly different between the two negative and positive blood culture groups (6.45 ng/mL vs 28.77 ng/mL, P＜0.001). Procalcitonin levels were found to be markedly higher in those with Gram-negative bacilli (mean±SD; 59.58±67.00 ng/mL) bacteremia than in those with Gram-positive cocci (mean±SD; 17.75±42.88 ng/mL) bacteremia (P＜0.001). The areas under the receiver operating characteristic curves (95% confidence interval) for PCT and CRP were 0.880 (0.820∼0.940) and 0.637 (0.538∼0.736), respectively. The use of a PCT level of 2 ng/mL as a cutoff value yielded an 83.6% positive predictive value and a 77.4% negative predictive value for the detection of bacteremia pathogens. Conclusion: Serum PCT is a helpful diagnostic marker for rapidly and accurately distinguishing between contaminants and pathogens in blood cultures.
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