肾功能受损对细菌性血流感染患者降钙素原的影响
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摘要
目的探讨细菌性血流感染患者肾功能对血清降钙素原(PCT)水平的影响。方法回顾性收集某院2014年5月—2017年11月双份血培养结果阳性且在血培养前后12 h内行血清PCT检查的病例,按照血培养病原菌革兰染色结果和肾功能水平进行分组,分为革兰阳性(G~+)菌肾功能正常组、G~+菌肾功能受损组(含重度受损组),革兰阴性(G~-)菌肾功能正常组、G~-菌肾功能受损组(含重度受损组)。分别比较组间PCT水平,用受试者工作特征(ROC)曲线评估PCT水平对肾功能损伤合并血流感染患者感染情况的预测价值。结果G~+菌肾功能正常组23例、受损组27例(含重度受损组11例),G~-菌肾功能正常组63例、受损组74例(含重度受损组23例)。G~+菌、G~-菌肾功能正常组与肾功能受损组患者PCT水平比较,差异均无统计学意义(均P>0.05);G~-菌肾功能正常组患者PCT水平为[2.63(0.58～9.28)]ng/m L,低于G~-菌肾功能重度受损组患者的[18.23(8.55～49.72)]ng/m L(P<0.001)。依据其PCT折点将G~-菌肾功能正常组与重度受损组患者的Ccr分为两部分(PCT水平>4.26 ng/m L和PCT水平≤4.26 ng/m L)绘制ROC曲线,曲线下面积(AUC)为0.664(P=0.009)。Ccr以71.81 m L/min为临界值时,患者PCT水平受到肾功能重度损伤影响的阳性预测值灵敏度为86.0%,特异度为51.2%。结论当患者肾功能重度受损合并G~-菌血流感染时,其PCT水平较肾功能正常患者判断脓毒血症的阈值(>0.5 ng/m L)需进一步提高。
ObjectiveTo evaluate the effect of renal function on serum procalcitonin in patients with bacterial bloodstream infection(BSI).MethodsPatients with double positive blood culture from May 2014 to November2017 and detected serum procalcitonin(PCT)12 hours before and after blood culture were analyzed retrospectively.They were grouped according to gram-staining result of pathogens from blood culture and renal function,four groups were gram-positive bacteria with normal renal function group(G~+/NRF group),gram-positive bacteria with impaired renal function group(including severely impaired)(G~+/IRF group),gram-negative bacteria with normal renal function group(G~-/NRF group),and gram-negative bacteria with impaired renal function group(including severely impaired)(G~-/IRF group).Levels of PCT among groups were compared,value of PCT level in predicting infection condition of patients with renal impairment and BSI was evaluated by receiver operating characteristic(ROC)curve.ResultsThere were 23 cases in G~+/NRF group,27 in G~+/IRF group(including 11 severely impaired cases),63in G~-/NRF group,and 74 in G~-/IRF group(including 23 severely impaired cases).PCT levels between G~+/NRF group and G~+/IRF group,as well as G~-/NRF group and G~-/IRF group were neither significantly different(both P>0.05);PCT level in G~-/NRF group was lower than that in severe G~-/IRF group(2.63[0.58-9.28]ng/mL VS 18.23[8.55-49.72]ng/mL,P<0.001).According to PCT break point,endogenous creatinine clearance rate(Ccr)of G~-/NRF group and severe G~-/IRF group was divided into two parts(PCT level>4.26 ng/mL and PCT level≤4.26 ng/mL),ROC curve was drawn,and the area under curve(AUC)was 0.664(P=0.009).When cutoff for Ccr was 71.81 mL/min,the sensitivity and specificity of positive predictive value of PCT level affected by severe impairment of renal function were 86.0%and 51.2%respectively.ConclusionWhen patient’s renal function is severely impaired and G~-bacteria BSI occurs,the threshold value of PCT level for judging sepsis needs to be further improved than patient with normal renal function(>0.5 ng/mL).
ObjectiveTo evaluate the effect of renal function on serum procalcitonin in patients with bacterial bloodstream infection(BSI).MethodsPatients with double positive blood culture from May 2014 to November2017 and detected serum procalcitonin(PCT)12 hours before and after blood culture were analyzed retrospectively.They were grouped according to gram-staining result of pathogens from blood culture and renal function,four groups were gram-positive bacteria with normal renal function group(G~+/NRF group),gram-positive bacteria with impaired renal function group(including severely impaired)(G~+/IRF group),gram-negative bacteria with normal renal function group(G~-/NRF group),and gram-negative bacteria with impaired renal function group(including severely impaired)(G~-/IRF group).Levels of PCT among groups were compared,value of PCT level in predicting infection condition of patients with renal impairment and BSI was evaluated by receiver operating characteristic(ROC)curve.ResultsThere were 23 cases in G~+/NRF group,27 in G~+/IRF group(including 11 severely impaired cases),63in G~-/NRF group,and 74 in G~-/IRF group(including 23 severely impaired cases).PCT levels between G~+/NRF group and G~+/IRF group,as well as G~-/NRF group and G~-/IRF group were neither significantly different(both P>0.05);PCT level in G~-/NRF group was lower than that in severe G~-/IRF group(2.63[0.58-9.28]ng/mL VS 18.23[8.55-49.72]ng/mL,P<0.001).According to PCT break point,endogenous creatinine clearance rate(Ccr)of G~-/NRF group and severe G~-/IRF group was divided into two parts(PCT level>4.26 ng/mL and PCT level≤4.26 ng/mL),ROC curve was drawn,and the area under curve(AUC)was 0.664(P=0.009).When cutoff for Ccr was 71.81 mL/min,the sensitivity and specificity of positive predictive value of PCT level affected by severe impairment of renal function were 86.0%and 51.2%respectively.ConclusionWhen patient’s renal function is severely impaired and G~-bacteria BSI occurs,the threshold value of PCT level for judging sepsis needs to be further improved than patient with normal renal function(>0.5 ng/mL).
引文
[1]降钙素原急诊临床应用专家共识组.降钙素原(PCT)急诊临床应用的专家共识[J].中华急诊医学杂志,2012,21(9):944-951.
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[4] Horan TC,Andrus M,Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting[J]. Am J Infect Control,2016,36(5):309-332.
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[8]中国医药教育协会感染疾病专业委员会.感染相关生物标志物临床意义解读专家共识[J].中华结核和呼吸杂志,2017,40(4):243-257.
[9] Sandkovsky U,Kalil AC,Florescu DF. The use and value of procalcitonin in solid organ transplantation[J]. Clin Transplant,2015,29(8):689-696.
[10]邓历.降钙素原在感染性疾病中的临床意义[J].职业与健康,2010,26(7):823-824.
[11] Tian G,Pan SY,Ma G,et al. Serum levels of procalcitonin as a biomarker for differentiating between sepsis and systemic inflammatory response syndrome in the neurological intensive care unit[J].J Clin Neurosci,2014,21(7):1153-1158.
[12]张立,林勇.降钙素原在呼吸系统感染性疾病诊断及治疗中的应用[J].东南大学学报(医学版),2011,30(4):643-648.
[13]刘息平,芦嘉,陈雪琴,等.血清降钙素原在危重患者细菌感染检测中的应用[J].中国现代医药杂志,2008,10(3):29-31.
[14] Gilbert DN. Use of plasma procalcitonin levels as an adjunct to clinical microbiology[J]. J Clin Microbiol,2010,48(7):2325-2329.
[15] Meisner M,Lohs T,Huettemann E,et al. The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function[J]. Eur J Anaesthesiol,2001,18(2):79-87.
[16]杨巧云,刘文明,俞建峰.伴/不伴急性肾损伤患者并发感染时降钙素原的表达差异[J].实用临床医药杂志,2016,20(3):162-164.
[17]颜瑶,郭晓芳,施青山,等.血清降钙素原在细菌性脓毒症合并急性肾损伤患者的诊断价值[J].中国中西医结合肾病杂志,2016,17(3):243-246.
[18]陈姣,张苗,蒋春明,等.血清降钙素原在诊断慢性肾脏病合并细菌感染中的临床价值[J].东南大学学报(医学版),2016,35(4):550-554.
[19]黄昭,王思荣,刘继云.血液灌流治疗对脓毒症急性肾损伤患者炎症因子的清除及肾脏保护作用[J].中华急诊医学杂志,2011,20(1):60-64.
[2] Vincent JL. Annual update in intensive care and emergency medicine 2016[M]. Springer International Publishing,2016.
[3] Herget-Rosenthal S,Klein T,Marggraf G,et al. Modulation and source of procalcitonin in reduced renal function and renal replacement therapy[J]. Scand J Immunol,2005,61(2):180-183.
[4] Horan TC,Andrus M,Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting[J]. Am J Infect Control,2016,36(5):309-332.
[5] Singer M,Deutschman CS,Seymour CW,et al. The Third international consensus definitions for sepsis and septic shock(sepsis-3)[J]. JAMA,2016,315(8):801-810.
[6]万学红,卢雪峰.诊断学[M]. 8版.北京:人民卫生出版社,2013:344.
[7]赵亮.早期血清降钙素原与细菌性血流感染病原菌相关性研究[J].中国医院药学杂志,2016,36(21):1904-1907.
[8]中国医药教育协会感染疾病专业委员会.感染相关生物标志物临床意义解读专家共识[J].中华结核和呼吸杂志,2017,40(4):243-257.
[9] Sandkovsky U,Kalil AC,Florescu DF. The use and value of procalcitonin in solid organ transplantation[J]. Clin Transplant,2015,29(8):689-696.
[10]邓历.降钙素原在感染性疾病中的临床意义[J].职业与健康,2010,26(7):823-824.
[11] Tian G,Pan SY,Ma G,et al. Serum levels of procalcitonin as a biomarker for differentiating between sepsis and systemic inflammatory response syndrome in the neurological intensive care unit[J].J Clin Neurosci,2014,21(7):1153-1158.
[12]张立,林勇.降钙素原在呼吸系统感染性疾病诊断及治疗中的应用[J].东南大学学报(医学版),2011,30(4):643-648.
[13]刘息平,芦嘉,陈雪琴,等.血清降钙素原在危重患者细菌感染检测中的应用[J].中国现代医药杂志,2008,10(3):29-31.
[14] Gilbert DN. Use of plasma procalcitonin levels as an adjunct to clinical microbiology[J]. J Clin Microbiol,2010,48(7):2325-2329.
[15] Meisner M,Lohs T,Huettemann E,et al. The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function[J]. Eur J Anaesthesiol,2001,18(2):79-87.
[16]杨巧云,刘文明,俞建峰.伴/不伴急性肾损伤患者并发感染时降钙素原的表达差异[J].实用临床医药杂志,2016,20(3):162-164.
[17]颜瑶,郭晓芳,施青山,等.血清降钙素原在细菌性脓毒症合并急性肾损伤患者的诊断价值[J].中国中西医结合肾病杂志,2016,17(3):243-246.
[18]陈姣,张苗,蒋春明,等.血清降钙素原在诊断慢性肾脏病合并细菌感染中的临床价值[J].东南大学学报(医学版),2016,35(4):550-554.
[19]黄昭,王思荣,刘继云.血液灌流治疗对脓毒症急性肾损伤患者炎症因子的清除及肾脏保护作用[J].中华急诊医学杂志,2011,20(1):60-64.