Evalution of serum procalcitonin level in differential diagnosis between systemic infection and local infection_West China Medical Journal

Authors：

TANG Jing , FANG Qingqing , CHEN Liyu ,  FENG Ping

Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

FENG Ping, Email: fengp_62@163.com

Keywords：

Procalcitonin; Sepsis; Local infection; Gram-positive bacteria; Gram-negative bacteria; Clinical significance

DOI：

10.7507/1002-0179.201702020

Video：

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Objective To explore the expression differences of procalcitonin (PCT) in different infection sites and bacterial strains, and to provide the evidence for early differential diagnosis of infectious diseases with PCT as a biomarker. Methods The patients with various kinds of infections diagnosed in West China Hospital of Sichuan University between January 2012 and June 2016 were retrospectively included. The expression differences of PCT in various infection sites and bacterial strains were analyzed. Results A total of 1 005 patients were include in this study, including 259 with systemic infection and 746 with local infection. The median PCT level in the systemic infection group was higher than that in the local infection group (8.57 vs. 0.10 ng/mL, P<0.05). In the 779 patients with pulmonary infection, the median PCT level of the patients with sepsis caused by pulmonary infection was higher than that of the ones without sepsis (4.61vs. 0.10 ng/mL, P<0.05), and the median PCT level of the patients with positive sputum culture was higher than that of the ones with negative sputum culture (0.28vs. 0.08 ng/mL, P<0.05). In the 48 patients with urinary tract infection, the median PCT level of the patients with sepsis caused by urinary tract infection was higher than that of the ones without sepsis (12.00vs. 0.42 ng/mL, P<0.05), and the median PCT level of the patients with complicated urinary tract infection was higher than that of the patients with simplex urinary tract infection (19.15vs. 5.02 ng/mL, P<0.05). In the 259 patients with systemic infection, the median PCT level of the patients with infective shock was higher than that of the ones without infective shock (40.26vs. 3.83 ng/mL, P<0.05); the mean PCT level of patients with infection of Gram-negative bacteria, Gram-positive bacteria and fungi was 13.66, 0.99, and 3.30 ng/mL with a significant difference (P<0.05). Conclusion The PCT level has unique advantages in identifying different sites of the infection, early diagnosing complicated urinary tract infection, and evaluating the severity of infection, which could provide evidence in early identification for sepsis caused by various kinds of infectious pathogens.

Citation： TANG Jing, FANG Qingqing, CHEN Liyu, FENG Ping. Evalution of serum procalcitonin level in differential diagnosis between systemic infection and local infection. West China Medical Journal, 2017, 32(12): 1867-1871. doi: 10.7507/1002-0179.201702020 Copy

1.	陳煒, 趙磊, 牛素平, 等. 不同炎癥因子對細菌性血流感染所致膿毒癥患者的早期診斷價值. 中華危重病急救醫學, 2014, 26(3): 165-170.
2.	蔡廣, 梁海波. 老年人肺部感染的血培養和痰培養分析. 實用心腦肺血管病雜志, 2001, 9(2): 1008-5971.
3.	Tziolos N, Kotanidou A, Orfanos SE. Biomarkers in infection and sepsis: can they really indicate final outcome?. Int J Antimicrob Agents, 2015, 46(1): S29-S32.
4.	降鈣素原急診臨床應用專家共識組. 降鈣素原(PCT)急診臨床應用的專家共識. 中華急診醫學雜志, 2012, 21(9): 944-951.
5.	Tavares E, Maldonado R, Ojeda ML, et al. Circulating inflammatory mediators during start of fever in differential diagnosis of gram-negative and gram-positive infections in leukopenic rats. Clin Diagn Lab Immunol, 2005, 12(9): 1085-1093.
6.	陳灝珠, 林果為. 實用內科學. 北京: 人民衛生出版社, 2009: 2217-2222.
7.	蔡柏薔, 李龍蕓. 協和呼吸病學. 2 版. 北京: 中國協和醫科大學出版社, 2011.
8.	Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab, 1994, 79(6): 1605-1608.
9.	蔣琳華. 血培養與血清降鈣素原聯合檢測的臨床意義. 國際檢驗醫學雜志, 2013, 34(22): 3102.
10.	唐龍, 段進進, 陳新軍, 等. 肺炎合并膿毒癥患者血清 hs CRP 和 PCT 水平的變化. 現代生物醫學進展, 2016, 16(35): 6929-6931.
11.	崔曉莉, 王忠勇, 趙宏勝, 等. 降鈣素原對重癥患者細菌感染預后的預測價值. 中華急診醫學雜志, 2013, 22(6): 630-633.
12.	高宏光, 唐時元, 朱姝姮, 等. 血清降鈣素原、C 反應蛋白對轉診肺炎合并膿毒癥患者預后的預測價值分析. 華西醫學, 2013, 28(9): 1342-1344.
13.	陳嘉利. 降鈣素原聯合病原體檢測在下呼吸道感染診斷中的應用觀察. 中國醫藥科學, 2015, 5(23): 126-128.
14.	郭曉艷, 姚紅霞. PCT 和微生物培養在 ICU 感染患者早期診斷中的應用. 中國醫學工程, 2014, 22(10): 49.
15.	Smellie JM, Poulton A, Prescod NP.. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ, 1994, 308(6938): 1193-1196.
16.	Sugimoto K, Adomi S, Koike H, et al. Procalcitonin as an indicator of urosepsis. Res Rep Urol, 2013, 5: 77-80.
17.	周帥偉. 降鈣素原與 C 反應蛋白在尿膿毒血癥早期診斷價值的臨床研究. 西寧: 青海大學, 2016.
18.	莊惠強, 葛亮, 林榮凱, 等. 降鈣素原在尿膿毒癥早期診斷中的應用價值. 現代泌尿外科雜志, 2017, 22(2): 119-122.
19.	仝義銳, 李延江, 荊濤, 等. 血漿降鈣素原對于復雜性上尿路感染導致尿膿毒血癥的預警作用研究. 臨床泌尿外科雜志, 2014, 29(7): 601-604.
20.	趙衛,曾富華. 血流感染及血液培養的臨床意義. 檢驗醫學與臨床, 2016, 13(24): 3570-3573.
21.	Iskander KN, Osuchowski MF, Stearns-Kurosawa DJ, et al. Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiol Rev, 2013, 93(3): 1247-1288.
22.	王麗娟, 王雅菲, 托婭, 等. PCT 與血流感染及膿毒癥相關的臨床應用進展. 內蒙古醫科大學學報, 2015(增刊2): 91-94.
23.	陳艷, 王天. 降鈣素原對膿毒血癥患者的早期診斷及預后判斷的意義. 中國醫藥指南, 2014(19): 45-46.
24.	朱翔, 許芳, 武其文. 降鈣素原在膿毒血癥患者早期診斷及預后評估中的意義. 臨床血液學雜志(輸血與檢驗), 2016, 29(6): 970-971.
25.	Scott MC. Defining and diagnosing sepsis. Emerg Med Clin North Am, 2017, 35(1): 1.
26.	Meisner M. Update on procalcitonin measurements. Ann Lab Med, 2014, 34(4): 263-273.
27.	Riedel S. Procalcitonin and the role of biomarkers in the diagnosis and management of sepsis. Diagn Microbiol Infect Dis, 2012, 73(3): 221-227.
28.	吳志恒, 郭玉霞, 卜婧, 等. 革蘭陰性菌和革蘭陽性菌血流感染危重患者中致炎癥反應的比較. 中國感染與化療雜志, 2012, 12(1): 27-31.
29.	Li S, Rong H, Guo Q, et al. Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis. J Res Med Sci, 2016, 21: 39.
30.	Pan YP, Fang YP, Xu YH, et al. The diagnostic value of procalcitonin versus other biomarkers in prediction of bloodstream infection. Clin Lab, 2017, 63(2): 277-285.
31.	劉英其. 血清降鈣素原在不同種類細菌膿毒癥的早期鑒別診斷價值. 中華醫院感染學雜志, 2013, 23(3): 500-502.

1. 陳煒, 趙磊, 牛素平, 等. 不同炎癥因子對細菌性血流感染所致膿毒癥患者的早期診斷價值. 中華危重病急救醫學, 2014, 26(3): 165-170.
2. 蔡廣, 梁海波. 老年人肺部感染的血培養和痰培養分析. 實用心腦肺血管病雜志, 2001, 9(2): 1008-5971.
3. Tziolos N, Kotanidou A, Orfanos SE. Biomarkers in infection and sepsis: can they really indicate final outcome?. Int J Antimicrob Agents, 2015, 46(1): S29-S32.
4. 降鈣素原急診臨床應用專家共識組. 降鈣素原(PCT)急診臨床應用的專家共識. 中華急診醫學雜志, 2012, 21(9): 944-951.
5. Tavares E, Maldonado R, Ojeda ML, et al. Circulating inflammatory mediators during start of fever in differential diagnosis of gram-negative and gram-positive infections in leukopenic rats. Clin Diagn Lab Immunol, 2005, 12(9): 1085-1093.
6. 陳灝珠, 林果為. 實用內科學. 北京: 人民衛生出版社, 2009: 2217-2222.
7. 蔡柏薔, 李龍蕓. 協和呼吸病學. 2 版. 北京: 中國協和醫科大學出版社, 2011.
8. Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab, 1994, 79(6): 1605-1608.
9. 蔣琳華. 血培養與血清降鈣素原聯合檢測的臨床意義. 國際檢驗醫學雜志, 2013, 34(22): 3102.
10. 唐龍, 段進進, 陳新軍, 等. 肺炎合并膿毒癥患者血清 hs CRP 和 PCT 水平的變化. 現代生物醫學進展, 2016, 16(35): 6929-6931.
11. 崔曉莉, 王忠勇, 趙宏勝, 等. 降鈣素原對重癥患者細菌感染預后的預測價值. 中華急診醫學雜志, 2013, 22(6): 630-633.
12. 高宏光, 唐時元, 朱姝姮, 等. 血清降鈣素原、C 反應蛋白對轉診肺炎合并膿毒癥患者預后的預測價值分析. 華西醫學, 2013, 28(9): 1342-1344.
13. 陳嘉利. 降鈣素原聯合病原體檢測在下呼吸道感染診斷中的應用觀察. 中國醫藥科學, 2015, 5(23): 126-128.
14. 郭曉艷, 姚紅霞. PCT 和微生物培養在 ICU 感染患者早期診斷中的應用. 中國醫學工程, 2014, 22(10): 49.
15. Smellie JM, Poulton A, Prescod NP.. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ, 1994, 308(6938): 1193-1196.
16. Sugimoto K, Adomi S, Koike H, et al. Procalcitonin as an indicator of urosepsis. Res Rep Urol, 2013, 5: 77-80.
17. 周帥偉. 降鈣素原與 C 反應蛋白在尿膿毒血癥早期診斷價值的臨床研究. 西寧: 青海大學, 2016.
18. 莊惠強, 葛亮, 林榮凱, 等. 降鈣素原在尿膿毒癥早期診斷中的應用價值. 現代泌尿外科雜志, 2017, 22(2): 119-122.
19. 仝義銳, 李延江, 荊濤, 等. 血漿降鈣素原對于復雜性上尿路感染導致尿膿毒血癥的預警作用研究. 臨床泌尿外科雜志, 2014, 29(7): 601-604.
20. 趙衛,曾富華. 血流感染及血液培養的臨床意義. 檢驗醫學與臨床, 2016, 13(24): 3570-3573.
21. Iskander KN, Osuchowski MF, Stearns-Kurosawa DJ, et al. Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiol Rev, 2013, 93(3): 1247-1288.
22. 王麗娟, 王雅菲, 托婭, 等. PCT 與血流感染及膿毒癥相關的臨床應用進展. 內蒙古醫科大學學報, 2015(增刊2): 91-94.
23. 陳艷, 王天. 降鈣素原對膿毒血癥患者的早期診斷及預后判斷的意義. 中國醫藥指南, 2014(19): 45-46.
24. 朱翔, 許芳, 武其文. 降鈣素原在膿毒血癥患者早期診斷及預后評估中的意義. 臨床血液學雜志(輸血與檢驗), 2016, 29(6): 970-971.
25. Scott MC. Defining and diagnosing sepsis. Emerg Med Clin North Am, 2017, 35(1): 1.
26. Meisner M. Update on procalcitonin measurements. Ann Lab Med, 2014, 34(4): 263-273.
27. Riedel S. Procalcitonin and the role of biomarkers in the diagnosis and management of sepsis. Diagn Microbiol Infect Dis, 2012, 73(3): 221-227.
28. 吳志恒, 郭玉霞, 卜婧, 等. 革蘭陰性菌和革蘭陽性菌血流感染危重患者中致炎癥反應的比較. 中國感染與化療雜志, 2012, 12(1): 27-31.
29. Li S, Rong H, Guo Q, et al. Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis. J Res Med Sci, 2016, 21: 39.
30. Pan YP, Fang YP, Xu YH, et al. The diagnostic value of procalcitonin versus other biomarkers in prediction of bloodstream infection. Clin Lab, 2017, 63(2): 277-285.
31. 劉英其. 血清降鈣素原在不同種類細菌膿毒癥的早期鑒別診斷價值. 中華醫院感染學雜志, 2013, 23(3): 500-502.

West China Medical Journal

Evalution of serum procalcitonin level in differential diagnosis between systemic infection and local infection

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