可溶性CD14亚型检测作为脓毒血症标志物的探讨
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摘要
目的探讨可溶性CD14亚型(sCD14-ST,Presepsin)与血培养结果的关系和对脓毒症的预测价值。方法以血培养结果将样本分成脓毒症组和非脓毒症组。同时检测血清降钙素原(PCT)、C反应蛋白(CRP)和Presepsin浓度,使用统计学方法比较Presepsin、降钙素原、C反应蛋白与血培养结果的符合率及正确性。结果Presepsin、PCT、CRP与血培养比较,Kappa值分别为0.835、0.612、0.412。ROC曲线结果显示:Presepsin的ROC曲线下面积为0.970,界值为546pg/mL时,灵敏度为82.0%;特异性为98.1%;准确性94.0%;PCT的ROC曲线下面积为0.908,界值为1.02μg/L时,灵敏度为77.5%;特异性为86.9%;准确性84.5%;CRP的ROC曲线下面积为0.797,界值为48.7mg/ml时,灵敏度为66.3%;特异性为78.8%;准确性75.6%。结论血清Presepsin水平与血培养结果高度相关,在诊断脓毒症的准确性方面优于降钙素原和C反应蛋白,可作为诊断脓毒症的早期指标。
Objective To investigate the relationship between soluble CD14 subtype(sCD14-ST,Presepsin)and blood culture results and the predictive value for sepsis.Methods The samples were divided into sepsis group and nonsepsis group in accordance with blood culture results.Serum procalcitonin(PCT),C-reactive protein(CRP)and Presepsin concentrations were also measured.Statistical methods were used to compare the coincidence and correctness of Presepsin,procalcitonin,C-reactive protein and blood culture results.Results Compared with blood culture,Presepsin,PCT and CRP the Kappa values were 0.835,0.612 and 0.412,respectively.The results of ROC curve showed that the area under the ROC curve of Presepsin was 0.970,the cutoff value was 546 pg/mL,the sensitivity was 82.0%,the specificity was 98.1%,the accuracy was 94.0%,and the area under the ROC curve of PCT was 0.908 with a cutoff value of 1.02μg/L,sensitivity is 77.5%,specificity is 86.9%,accuracy is 84.5%.CRP has an ROC curve area of 0.797,a cutoff value of 48.7 mg/ml,a sensitivity of 66.3%,and a specificity of 78.8%and 75.6%respectively.Conclusion Serum Presepsin level is highly correlated with blood culture results and may be superior to procalcitonin and CRP in the diagnosis of sepsis.It can be used as an early indicator for the diagnosis of sepsis.
Objective To investigate the relationship between soluble CD14 subtype(sCD14-ST,Presepsin)and blood culture results and the predictive value for sepsis.Methods The samples were divided into sepsis group and nonsepsis group in accordance with blood culture results.Serum procalcitonin(PCT),C-reactive protein(CRP)and Presepsin concentrations were also measured.Statistical methods were used to compare the coincidence and correctness of Presepsin,procalcitonin,C-reactive protein and blood culture results.Results Compared with blood culture,Presepsin,PCT and CRP the Kappa values were 0.835,0.612 and 0.412,respectively.The results of ROC curve showed that the area under the ROC curve of Presepsin was 0.970,the cutoff value was 546 pg/mL,the sensitivity was 82.0%,the specificity was 98.1%,the accuracy was 94.0%,and the area under the ROC curve of PCT was 0.908 with a cutoff value of 1.02μg/L,sensitivity is 77.5%,specificity is 86.9%,accuracy is 84.5%.CRP has an ROC curve area of 0.797,a cutoff value of 48.7 mg/ml,a sensitivity of 66.3%,and a specificity of 78.8%and 75.6%respectively.Conclusion Serum Presepsin level is highly correlated with blood culture results and may be superior to procalcitonin and CRP in the diagnosis of sepsis.It can be used as an early indicator for the diagnosis of sepsis.
引文
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[2]Levy MM,dellinger RP,Townsend SR,et al.The Surviving Sepsis Campaign:results of an international guideline-based performance improvement program targeting severe sepsis[J].Intensive Care Med,2010,36(2):222.
[3]Dellinger RP,Levy MM,Rhodes A,et al.Surviving sepsis campaign guidelines committee including the pediatric subgroup:surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J].Crint Care Med,2013,41(2):580.
[4]高戈,冯喆,常志,等.2012国际严重脓毒症及脓毒症休克诊疗指南[J].中华危重病急救医学,2013,25(8):501.
[5]保勇,史梦,张欣,等.降钙素原与血培养联合检测以改善脓毒症诊断的敏感性及协助鉴别污染菌[J].四川医学,2013,34(12):1903.
[6]苏明环,寿松涛.血presepsin对脓毒症诊断及病情判断的临床价值[J].临床检验杂志,2014,32(2):106.
[7]Shirakawa k,Furusako S,Endo S,et al.New diagnostic marker for sepsis:soluble CD14subtype[J].Crit Care,2004,8(Suppl 1):191.
[8]Ulla M.Pizzolato E.Lucchiari M,et al.Diagnostic and prognostic valuc of prescpsin in the managcmcnl of seosis in the emergency depantment:a multicenter prospective study[J].Critical Care,2013,17(4):R168.
[9]Liu B,Chen YX,Yin Q,et al.Diagnostic value and prognostic cvaluation ofpresepsin for sepsis in an emergency department[J].Crit Care,2013,17(5):R244.