The Clinical Value of Procalcitonin inDiagnosis of Patients with Fever
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목 적:최근 프로칼시토닌이 전신 증상이 있는 세균 감염의 한 임상 지표로 제시되어왔다. 이에 이번 연구에서는 프로칼시토닌이 패혈증 증후군 환자군과 국소감염군/비감염군을 구분할 수 있는지를 보기 위해 시행되었다. 재료 및 방법:발열로 내원한 71명의 환자를 대상으로 전향적으로 시행되었다. 진단된 환자군은 비감염군 16명, 국소감염군 25명, 패혈증군 15명, 패혈성 쇼크 15명이었다. 지금까지 감염의 치료들로 알려져 있던 지표들 중 ESR, CRP, IL-6와 프로칼시토닌에 대한 패혈증/패혈성 쇼크군과 국소감염/비감염군 사이를 구분할 수 있는 ROC 곡선값을 구하였고, 가장 ROC값이 높은 지표의 패혈증을 예측할 수 있는 예민도와 특이도를 결정하였다. 결과:PCT 중앙값은 비감염군에서 0.85 (0.747-1.57) ng/mL, 국소감염군에서 1.28 (0.73-2.33) ng/mL, 패혈증군에서 2.59 (1.87-9.0) ng/mL, 패혈성 쇼크군에서 23.9 (23.1-126.1) ng/mL이였다. 프로칼시토닌은 패혈증군을 구분하는데 있어 가장 높은 AUC값을 보여 0.889 (CI; 0.81-0.97)였고, IL-6 (0.779; 0.65- 0.90), CRP (0.642; 0.51-0.78), 그리고 ESR (0.412; 0.28-0.56)의 순이었다. 프로칼시토닌 1.73 ng/mL의 차단값이 예민도 86.5%, 특이도 75.6%, 양성예측도 72.2%, 음성예측도 88.6%였다. 결 론:프로칼시토닌 값은 발열로 입원하는 환자들을 국소감염이나 비감염과 패혈증 환자를 구분하는데 유용하다.
Abstract
Background : Procalcitonin (PCT) has been suggested as a marker of bacterial infection with systemic manifestation. The purpose of this study was to determine whether PCT level can be used to discriminate between the sepsis or septic shock and localized infection or non-infection.Materials and Methods : This was a prospective study involving 71 patients who presented with fever. The final diagnosis was inflammation without infection in 16, localized infection in 25, sepsis in 15, and septic shock in 15. We compared the different parameters of infection- erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), interleukin-6 (IL-6), and PCT - by comparing the area under the receiver operating characteristic curves (AUCs) of sepsis/or septic shock and localized infection/or non-infection. We also determined the predictive power of PCT in detecting sepsis.Results : The median PCT concentrations were 0.85 (range, 0.747-1.57) ng/mL for non-infection, 1.28 (0.73- 2.33) ng/mL for localized infection, 2.59 (1.87-9.0) ng/ mL for sepsis, and 23.9 (23.1-126.1) ng/mL for septic shock. PCT exhibited the highest discriminative value, with an AUC of 0.889 (95% CI, 0.81-0.97), followed by IL-6 (0.779; CI, 0.65-0.90), CRP (0.642; CI, 0.51-0.78), and ESR (0.412; CI, 0.28-0.56). At a cutoff value of 1.73 ng/mL, PCT showed sensitivity of 86.5%, specificity of 75.6%, positive predictive value of 72.2%, and negative predictive value of 88.6%.Conclusion : The PCT concentrations could be used to help discriminate sepsis in newly admitted febrile patients.
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