응급실의 전신염증반응 증후군 환자에서 프로칼시토닌의 유용성
The Utility of Serum Procalcitonin Levels in the Management of Systemic Inflammatory Response Syndrome in the Emergency Department
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: The aim of this study was to investigate whether obtaining serum procalcitonin (PCT) levels in patients with systemic inflammatory response syndrome (SIRS) helps the differential diagnosis between sepsis and non-sepsis and predicts disease severity in the emergency department (ED). Methods: This prospective study enrolled 132 consecutive adult patients with SIRS who visited the ED. Serum C-reactive protein (CRP) levels and serum PCT levels were compared between sepsis and non-sepsis groups upon ED admission. Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score (MODS), and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were calculated, and their correlations with CRP and PCT levels were evaluated. The PCT and CRP levels were assessed to predict sepsis in terms of comparing receiver operating characteristic (ROC) curves. Results: Eighty patients were included in the sepsis group. The levels of PCT and CRP in the sepsis group were significantly higher. In the sepsis group, the initial serum PCT correlated with the SOFA and MODS scores, and this also correlated in the non-sepsis group, but CRP did not. No differences were found when the PCT and CRP ROCs were compared. Conclusions: Correlation between PCT and severity in the non-sepsis group is considered to be clinically meaningless because of low levels. Additionally, PCT levels had similar diagnostic value for sepsis as CRP levels. PCT is recommended for prediction of severity in sepsis patients in ED, but not for differential diagnosis between sepsis and non-sepsis.
Abstract
Background: The aim of this study was to investigate whether obtaining serum procalcitonin (PCT) levels in patients with systemic inflammatory response syndrome (SIRS) helps the differential diagnosis between sepsis and non-sepsis and predicts disease severity in the emergency department (ED). Methods: This prospective study enrolled 132 consecutive adult patients with SIRS who visited the ED. Serum C-reactive protein (CRP) levels and serum PCT levels were compared between sepsis and non-sepsis groups upon ED admission. Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score (MODS), and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were calculated, and their correlations with CRP and PCT levels were evaluated. The PCT and CRP levels were assessed to predict sepsis in terms of comparing receiver operating characteristic (ROC) curves. Results: Eighty patients were included in the sepsis group. The levels of PCT and CRP in the sepsis group were significantly higher. In the sepsis group, the initial serum PCT correlated with the SOFA and MODS scores, and this also correlated in the non-sepsis group, but CRP did not. No differences were found when the PCT and CRP ROCs were compared. Conclusions: Correlation between PCT and severity in the non-sepsis group is considered to be clinically meaningless because of low levels. Additionally, PCT levels had similar diagnostic value for sepsis as CRP levels. PCT is recommended for prediction of severity in sepsis patients in ED, but not for differential diagnosis between sepsis and non-sepsis.
참고문헌 (29)
- Martin GS, "The epidemiology of sepsis in the United States from 1979 through 2000", N Engl J Med, 348, pp.1546~1554 (2000)
- Friedman G, "Has the mortality of septic shock changed with time", Crit Care Med, 26, pp.2078~2086 (1998)
- Bochud PY, "Antimicrobial therapy for patients with severe sepsis and septic shock: an evidence-based review", Crit Care Med, 32, pp.S495~S512 (2004)
- Hatherill M, "Procalcitonin and cytokine levels: relationship to organ failure and mortality in pediatric septic shock", Crit Care Med, 28, pp.2591~2594 (2000)
- Gogos CA, "Pro- versus anti-inflammatory cytokine profile in patients with severe sepsis: a marker for prognosis and future therapeutic options", J Infect Dis, 181, pp.176~180 (2000)
- Pettilä V, "Predictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis", Intensive Care Med, 28, pp.1220~1225 (2002)
- Le Moullec JM, "The complete sequence of human preprocalcitonin", FEBS Lett, 167, pp.93~97 (1984)
- Assicot M, "High serum procalcitonin concentrations in patients with sepsis and infection", Lancet, 341, pp.515~518 (1993)
- Wanner GA, "Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients", Crit Care Med, 28, pp.950~957 (2000)
- Carsin H, "Evolution and significance of circulating procalcitonin levels compared with IL-6, TNF alpha and endotoxin levels early after thermal injury", Burns, 23, pp.218~224 (1997)
- Nylén ES, "Effect of classic heatstroke on serum procalcitonin", Crit Care Med, 25, pp.1362~1365 (1997)
- Vincent JL, "Use of the SOFA score to assess the incidence of organ dysfunction", failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine, 1998, pp.26, 1793~1800
- Marshall JC, "Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome", Crit Care Med, 23, pp.1638~1652 (1995)
- Knaus WA, "The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults", Chest, 100, pp.1619~1636 (1991)
- "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
- Póvoa P, "C-reactive protein as an indicator of sepsis", Intensive Care Med, 24, pp.1052~1056 (1998)
- Miller PR, "Systemic inflammatory response syndrome in the trauma intensive care unit: who is infected?", J Trauma, 47, pp.1004~1008 (1999)
- Black S, "c-reactive protein", J Biol Chem, 279, pp.48487~48490 (2004)
- Viallon A, "an emergency physicians identify a high mortality subgroup of patients with sepsis: role of procalcitonin", Eur J Emerg Med, 15, pp.26~33 (2008)
- 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)
- Dandona P, "Procalcitonin increase after endotoxin injection in normal subjects", J Clin Endocrinol Metab, 79, pp.1605~1608 (1994)
- Guven H, "Diagnostic value of procalcitonin levels as an early indicator of sepsis", Am J Emerg Med, 20, pp.202~206 (2002)
- Luzzani A, "Comparison of procalcitonin and C-reactive protein as markers of sepsis", Crit Care Med, 31, pp.1737~1741 (2003)
- Wunder C, "Are IL-6, IL-10 and PCT plasma concentrations reliable for outcome prediction in severe sepsis? A comparison with APACHE III and SAPS II", Inflamm Res, 53, pp.158~163 (2004)
- Meisner M, "Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS", Crit Care, 3, pp.45~50 (1999)
- Balci C, "Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit", Crit Care, 7, pp.85~90 (2003)
- Müller B, "Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia", BMC Infect Dis, 7, pp.10~ (2007)
- Chan YL, "Procalcitonin as a marker of bacterial infection in the emergency department: an observational study", Crit Care, 8, pp.R12~R20 (2004)
- Becker KL, "Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors", J Clin Endocrinol Metab, 89, pp.1512~1525 (2004)