혈액 배양 양성 패혈증 환자에서 프로칼시토닌과 C-반응성 단백의 진단 유용성 비교 분석
Comparison of Diagnostic Utility between Procalcitonin and C-Reactive Protein for the Patients with Blood Culture-Positive Sepsis
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배경 : 프로칼시토닌(procalcitonin, PCT)은 세균 감염에 대 한 비교적 새로운 표지자로서, PCT의 진단적 유용성은 연구마 다 다양하게 보고되어 왔다. 저자들은 혈액 배양 양성 패혈증 환자에서 반응성 C-단백(C-reactive protein, CRP)과 비교하 여 PCT의 진단적 유용성을 평가해보고자 하였다. 방법 : 1,270개의 검체를 대상으로 PCT의 다섯 구간(0.05 ng/mL 미만; 0.05-0.49 ng/mL; 0.5-1.99 ng/mL; 2-9.99 ng/mL; 10 ng/mL 이상)에서 각각 PCT과 CRP를 측정하여 비 교하였다. 506 검체에서는 혈액 배양 결과에 따라 추가 분석을 시행하였다. PCT은 효소연관 형광검사법(bioMerieux Co., Lyon, France)으로 측정하였고, CRP는 비율 비탁법(Beckman Coulter Co., USA)으로 측정하였다. 상대수행능곡선을 구하여 PCT과 CRP의 진단적 유용성을 비교하였다. 결과 : PCT의 각 구간에서 CRP 농도는 15.4 mg/L, 42.1 mg/L, 101.2 mg/L, 125.0 mg/L, 167.1 mg/L로서 유의한 차 이가 있었다(P<0.0001). 혈액 배양 양성군과 음성군 간 PCT과 CRP의 평균 농도는 유의한 차이가 있었다(8.47 ng/mL vs 2.44 ng/mL, P=0.0133; 110.48 mg/L vs 59.78 mg/L, P<0.0001). PCT과 CRP의 상대수행능곡선의 아래면적(95% 신뢰구간)은 0.720 (0.644-0.788)과 0.558 (0.478-0.636)로 유의한 차이 가 있었다(P=0.005). 결론 : 본 연구의 결과는 혈액 배양 양성 패혈증 환자에서 PCT의 진단적 유용성이 CRP의 진단적 유용성에 비해 우수함 을 보여주고 있다. PCT은 패혈증 진단을 위한 신뢰할 수 있는 표지자로 생각되며, 중환자의 치료에 유용한 임상 정보를 제공 할 수 있을 것이다.
Abstract
Background : Procalcitonin (PCT) is a relatively new marker for bacterial infections, and its diagnostic utility has been variable across the studies. We investigated the diagnostic utility of PCT for the patients with blood culture-positive sepsis, and compared it with that of C-reactive protein (CRP). Methods : In 1,270 consecutive blood samples, PCT and CRP were simultaneously measured and results were compared according to the five categories of PCT concentrations (<0.05 ng/mL; 0.05-0.49 ng/mL; 0.5-1.99 ng/mL; 2-9.99 ng/mL; ≥10 ng/mL). In 506 samples, they were further analyzed according to the result of blood culture. PCT and CRP were measured using enzyme-linked fluorescent assay (bioMerieux Co., France) and rate nephelometry (Beckman Coulter Co., USA), respectively. Their diagnostic utilities were compared using ROC curves. Results : The mean concentrations of CRP in five categories of PCT were 15.4 mg/L, 42.1 mg/L, 101.2 mg/L, 125.0 mg/L, 167.1 mg/L, respectively (P<0.0001). Both PCT and CRP showed significant differences between the two positive and negative groups of blood culture (PCT, 8.47 vs 2.44 ng/mL, P=0.0133; CRP, 110.48 vs 59.78 mg/L, P<0.0001). The areas under the ROC curves (95% confidence interval) for PCT and CRP were 0.720 (0.644-0.788) and 0.558 (0.478-0.636), respectively, and showed a significant difference (P=0.005). Conclusions : The diagnostic utility of PCT is superior to that of CRP for the patients with blood culture-positive sepsis. PCT seems to be reliable for sepsis diagnosis, and may provide useful information for the critically ill patients.
참고문헌 (27)
- Pfäfflin A, "Inflammation markers in point-of-care testing (POCT)", Anal Bioanal Chem, 393, pp.1473~1480 (2009)
- "American College of Chest Physicians", Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis, 1992, pp.20, 864~874
- Levy MM, "2001 SCCM", ESICM, ATS, pp.SIS International Sepsis Definitions Conference, Crit Care Med[DOI]
- Mitaka C, "Clinical laboratory differentiation of infectious versus noninfectious systemic inflammatory response syndrome", Clin Chim Acta, 351, pp.17~29 (2005)
- Meisner M, "Pathobiochemistry and clinical use of procalcitonin", Clin Chim Acta, 323, pp.17~29 (2002)
- Becker KL, "Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations", Crit Care Med, 36, pp.941~952 (2008)
- Chua AP, "Procalcitonin in severe acute respiratory syndrome (SARS)", J Infect, 48, pp.303~306 (2004)
- Cone JB, "Inflammation", Am J Surg, 182, pp.558~562 (2001)
- Luster AD, "Chemokines-chemotactic cytokines that mediate inflammation", N Engl J Med, 338, pp.436~445 (1998)
- Simon L, "Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis", Clin Infect Dis, 39, pp.206~217 (2004)
- Whicher J, "Procalcitonin as an acute phase marker", Ann Clin Biochem, 38, pp.483~493 (2001)
- Nijsten MW, "Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro", Crit Care Med, 28, pp.458~461 (2000)
- Assicot M, "High serum procalcitonin concentrations in patients with sepsis and infection", Lancet, 341, pp.515~518 (1993)
- Brunkhorst FM, "Procalcitonin, C-reactive protein and APACHE II score for risk evaluation in patients with severe pneumonia", Clin Microbiol Infect, 8, pp.93~100 (2002)
- Oberhoffer M, "Outcome prediction by traditional and new markers of inflammation in patients with sepsis", Clin Chem Lab Med, 37, pp.363~368 (1999)
- Rau BM, "Evaluation of procalcitonin for predicting septic multiorgan failure and overall prognosis in secondary peritonitis: a prospective, international multicenter study", Arch Surg, 142, pp.134~142
- Rau B, "Procalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis", Langenbecks Arch Surg, 389, pp.134~144 (2004)
- Liaudat S, "Usefulness of procalcitonin serum level for the diagnosis of bacteremia", Eur J Clin Microbiol Infect Dis, 20, pp.524~527 (2001)
- Whang KT, "Serum calcitonin precursors in sepsis and systemic inflammation", J Clin Endocrinol Metab, 83, pp.3296~3301 (1998)
- Uzzan B, "Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis", Crit Care Med, 34, pp.1996~2003 (2006)
- Boussekey N, "Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit", Infection, 33, pp.257~263 (2005)
- Thayyil S, "Is procalcitonin useful in early diagnosis of serious bacterial infections in children?", Acta Paediatr, 94, pp.155~158 (2005)
- Harbarth S, "Diagnostic value of procalcitonin, interleukin-6 and interleukin-8 in critically ill patients admitted with suspected sepsis", Am J Respir Crit Care Med, 164, pp.396~402 (2001)
- Müller B, "Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit", Crit Care Med, 28, pp.977~983 (2000)
- Povoa P, "C-reactive protein as an indicator of sepsis", Intensive Care Med, 24, pp.1052~1056 (1998)
- Aikawa N, "Multicenter prospective study of procalcitonin as an indicator of sepsis", J Infect Chemother, 11, pp.152~159 (2005)
- Endo S, "Usefulness of procalcitonin serum level for the discrimination of severe sepsis from sepsis: a multicenter prospective study", J Infect Chemother, 14, pp.244~249 (2008)