Objective To investigate the clinical value of peripheral serum cell-free DNA/neutrophil extracellular traps (cf-DNA/NETs) level in diagnosis and severity assessment of sepsis patients. Methods Forty patients with sepsis and 40 patients with non-infectious systemic inflammatory response syndrome (nf-SIRS) were enrolled in this study. The cf-DNA/NETs level in serum of all subjects were measured. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic ability of the cf-DNA/NETs, white blood cell count (WBC), procalcitonin (PCT) and interleukin-6 (IL-6). The sepsis patients were stratified into a survival group and a death group according to the prognosis. Sequential organ failure (SOFA) score were recorded in the sepsis patients, and the correlations between SOFA and cf-DNA/NETs, PCT, WBC, IL-6 were analyzed. Results Compared with the nf-SIRS group, cf-DNA/NETs and PCT levels were significantly higher in the sepsis group (both P<0.05). WBC and IL-6 showed no significant differences between the two groups (bothP>0.05). The area under the ROC curve (AUC) of cf-DNA/NETs was 0.884 for diagnosis of sepsis, and it was higher than the AUC of PCT (0.803). The cf-DNA/NETs showed better sensitivity (81.2% and 79.2%) and specificity (81.0% and 82.4%) than PCT. cf-DNA/NETs and PCT were significantly higher in the death group than those in the survival group. Bivariate collection analysis revealed positive correlations between SOFA score and the two biomarkers of cf-DNA/NETs and PCT (r1=0.573, r2=0.518; both P<0.01). Conclusions cf-DNA/NETs and PCT have certain value in early diagnosis of sepsis, and cf-DNA/NETs shows better diagnostic value in distinguishing sepsis from nf-SIRS than PCT. cf-DNA/NETs can be used as a routine monitoring index to help assess disease severity in sepsis.
Objective To evaluate the predicting effect of quick Sequential Organ Failure Assessment (qSOFA) on septic shock, and investigate the probability of improving the predicting effect. Methods Patients with sepsis diagnosed in Emergency Department from July 2015 to June 2016 were enrolled. They were divided into shock group and non-shock group based on whether or not they had septic shock during 72 hours after admission. The multivariate logistic regression analysis was used to find out the independent risk factors affecting the incidence of septic shock. Receiver operating characteristic (ROC) curve was used to analyze those risk factors. Modified Early Warning Score (MEWS), Mortality in Emergency Department Sepsis Score (MEDS), Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic HealthEvaluation (APACHE)Ⅱ and qSOFA were also compared with ROC curve analysis. The possibility of improvement of qSOFA predicting effect was discussed. Results A total of 821 patients were enrolled, with 108 in septic shock group and 713 in non-septic shock. The result of multivariate logistic regression analysis indicated that respiratory rate, systolic blood pressure, pH value, oxygenation index, lactate, albumin, Glasgow Coma Score and procalcitonin were the independent risk factors (P<0.05). The result of ROC analysis showed that the area under curve (AUC) of pH value, lactate and procalcitonin was 0.695, 0.678 and 0.694, respectively. Lactate had the highest value of specificity (0.868), positive predictive value (0.356) and positive likelihood ratio (3.644), while the sensitivity (0.889) and negative predictive value (0.961) of procalcitonin were the highest. MEWS, MEDS, SOFA, APACHEⅡ and qSOFA were compared with ROC. SOFA had the best predicting effect with the statistical results of AUC (0.833), sensitivity (0.835), specificity (0.435), positive predictive value (0.971), negative predictive value (0.971), and positive likelihood ratio (5.048); and MEWS had the highest negative likelihood ratio (0.581). qSOFA did not show a best predicting value. Conclusion qSOFA is not the best choice to predict the possibility of septic shock, but its predicting value might be improved when combined with pH value, lactate and procalcitonin.
ObjectiveTo investigate the diagnostic value of products triggered by endotoxin including cytokines and procalcitonin for differentiating bacterial pneumonia from pulmonary tuberculosis. MethodsFifty patients diagnosed to have hospital-acquired pneumonia and another 50 patients diagnosed with tuberculosis admitted into West China Hospital between January and August 2015 were recruited in this study. The frequencies of CD4+ interferon (IFN)-γ+, CD4+ tumor necrosis factor (TNF)-α+, CD4+ interleukin (IL)-2+, CD4+ IL-10+ as well as CD8+IFN-γ+, CD8+TNF-α+, CD8+IL-2+, CD8+IL-10+ populations in peripheral blood were detected by flow cytometry after endotoxin stimulation. Meanwhile, the levels of procalcitonin, IL-6 and C reactive protein were measured by immunofluorescence staining. ResultsThe frequencies of CD4+ IFN-γ+, CD4+ TNF-α+, CD4+ IL-2+, CD4+ IL-10+ as well as CD8+ IFN-γ+, CD8+ TNF-α+, CD8+ IL-2+, CD8+ IL-10+ populations in the pneumonia group increased significantly compared with those in the tuberculosis group (P < 0.05). The levels of procalcitonin, IL-6 and C-reactive protein in the pneumonia group increased statistically compared with the counterparts in the tuberculosis group (P < 0.05). The positive rates of procalcitonin, IL-6 and C-reactive protein in the pneumonia group were significantly higher than those in the tuberculosis group (P < 0.05). ConclusionMeasurement of products triggered by endotoxin is beneficial for differential diagnosis of pneumonia from tuberculosis.
ObjectiveTo investigate the role of dynamic monitoring procalcitonin (PCT) in the comprehensive evaluation during the diagnosis and treatment of community acquired pneumonia (CAP). MethodsFour hundred and sixty-eight patients with CAP were randomly assigned to a PCT-guided group (the research group) and a standard guideline group (the control group). The clinical symptoms,CURB-65 grade,blood leucocyte count and classification,and C-reactive protein (CRP)were compared between two groups. The PCT-guided application time of antibiotics,the hospitalization time,chest CT examination rate,the cure or the improvement rate were also estimated and commpared. ResultsThe hospitalization time [(9.6±1.7)days vs. (10.9±1.6)days],hospitalization cost [(6 957.11±1 009.46) yuan vs. (8 011.35±1 049.77) yuan],chest CT examination rate (56.96% vs. 89.40%),the application time of antibiotics [(16.5±2.3)days vs. (20.0±1.2)days],and the rate of required antibiotics upgrade (6.96% vs. 11.06%) in the research group were all significantly lower than the control group (P<0.05). There was no significant difference between two groups in the ratio of the adverse reaction of antibiotics (14.78% vs. 15.20%),the rate of transfer into ICU (2.61% vs. 3.69%) or the mortality (1.74% vs. 2.30%)(P>0.05). ConclusionOn the basis of CAP guidelines,the dynamic monitoring of PCT may shorten the time of antibiotic use and the hospitalization,reduce the cost of hospitalization and the rate of chest CT scan in patients with CAP.
ObjectiveTo investigate the prognostic value of serum procalcitonin (PCT) level and its change for patients with severe trauma and sepsis. MethodsEighty-two patients with severe trauma and sepsis treated between June 2013 and June 2014 were chosen to be our study subjects. According to the clinical outcome at day 28, they were divided into survival group (n=54) and death group (n=28). Serum procalcitonin levels at hour 0, 24, 48, 72, 96, and 120 after admitted to the emergency intensive care unit were detected in all the patients. Then we calculated the rate of procalcitonin change in each time points, injury severity score (ISS) score, acute physiology and chronic health evaluation (APACHE)Ⅱ score and white blood cells (WBC) count. ResultsProcalciton level at hour 24, 48, 72, 96 and 120 of the survival group was significantly lower than the death group (P<0.05); the rate of procalcitonin change at hour 24, 48, 72, 96 and 120 was significantly lower than the death group (P<0.05), and the APACHE Ⅱ score was significantly lower than the death group (P<0.01). There was no significant difference in the ISS score and WBC count between the two groups (P>0.05). ConclusionEarly procalcitonin level and its dynamic change are good indicators in judging the prognosis of patients with severe trauma and sepsis, especially the early dynamic change in the rate of procalcitonin.
目的 探讨血清降钙素原（PCT）、C反应蛋白（CRP）与急性生理及慢性健康评分标准Ⅱ（APACHE Ⅱ）评分在转诊肺炎合并脓毒症患者诊断中的相关性，以寻找更为简洁、快速判断其病情严重程度的指标。 方法 2009年1月－2010年12月，选取178例转诊肺炎合并脓毒症患者并进行脓毒症分级，对其进行血清PCT和CRP测定，并与APACHE Ⅱ评分及预后进行相关性分析。 结果 严重脓毒症组及脓毒性休克组患者血清PCT、CRP水平与APACHE Ⅱ评分较全身炎症反应综合征组及脓毒症组高（P＜0.05）；30 d内死亡的患者其血清PCT、CRP水平及APACHEⅡ评分较存活组明显增高（P＜0.05）；转诊肺炎合并脓毒症患者血清PCT与APACHE Ⅱ评分呈正相关（r=0.683，P=0.023），与血清CRP水平呈较弱的正相关（r=0.272，P=0.037）。 结论 对转院肺炎合并脓毒症患者进行血清PCT和CRP测定，对病情评估具有一定临床价值，特别是PCT可作为对转诊肺炎合并脓毒症患者病情程度判断的重要指标，为早期干预及治疗提供依据，值得临床推广应用。
ObjectiveTo summarize the clinical value of procalcitonin (PCT) in the prediction of early stage of acute pancreatitis, the evaluation of therapeutic effect, the evaluation of prognosis, and the use of antibiotics.MethodWe reviewed the related literatures about hematology indexes of severe acute pancreatitis and pancreatic infection and necrosis at home and abroad in recent years.ResultsPCT had high sensitivity and specificity in the diagnosis of severe acute pancreatitis and pancreatic infection and necrosis, and could be used as a tool to guide the early clinical treatment of severe acute pancreatitis. In the course of treatment, with the improvement of the condition, the value of PCT decreased. Monitoring the change of PCT value could evaluate the therapeutic effect of severe acute pancreatitis. Monitoring PCT during treatment could also guide the use of antibiotics.ConclusionPCT can be used as an early indicator for predicting severe acute pancreatitis and necrosis of pancreatic infection, as well as an indicator for guiding antibiotic treatment.
ObjectiveTo systematically evaluate the efficacy and safety of procalcitonin guided algorithms of antibiotic therapy in acute exacerbation chronic obstructive pulmonary disease (AECOPD). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 6, 2016), CBM, CNKI, VIP, and WanFang Data from the date of their establishment to July 2016, to collect randomized controlled trials (RCTs) about procalcitonin guided antibiotics therapy in patients with AECOPD. References of the included literature were also searched manually for additional studies. The literature screening, data extraction and bias risk assessment of the included studies were completed by two reviewers independently. Statistical analysis was conducted using RevMan 5.2 software. ResultsA total of ten RCTs involving 1 071 patients were included. The results of meta-analysis indicated that compared with the standard treatment group, the antibiotic prescription rate (RR=0.70, 95% CI 0.55 to 0.89, P=0.004), the rate of duration of antibiotic >10 days (RR=0.38, 95% CI 0.26 to 0.56, P<0.000 01) and the superinfection rate (RR=0.23, 95% CI 0.09 to 0.58, P=0.002) were significantly lower in the procalcitonin-guided treatment group. There were no statistical differences in clinical effective rate (RR=0.98, 95% CI 0.91 to 1.06, P=0.61), hospital mortality (RR=0.84, 95% CI 0.52 to 1.73, P=0.43), and the rate of need for intensive care (RR=0.77, 95% CI 0.40 to 1.47, P=0.43). ConclusionProcalcitonin guided antibiotics therapy may reduce antibiotic exposure and superinfection rate in patients with AECOPD. In addition, due to the low methodological quality and limited quantity of the included studies, larger sample-size, and high quality RCTs are needed to verify the above conclusion.
ObjectiveTo assess the diagnostic value of procalcitonin (PCT) and/or (1,3)-β-D-glucan test (serum BG assay) for pulmonary infection. MethodsWe collected 1 027 cases randomly from January 24th, 2013 to January 25th, 2014. First, we accumulated isolates from these cases in sputum culture. Second, we compared PCT and sputum culture, serum BG assay and sputum culture, CT and serum BG assay. Then we accumulated these PCT and studied its distribution when PCT>0.5 ng/mL and when their sputum culture was positive. We also accumulated these serum BG assay results and studied its distribution when their sputum culture was positive for aspergillus or suggested aspergillus infection by CT. Finally, we estimated the significance of the combined use of PCT and serum BG assay for diagnosis of pulmonary infection. ResultsIn these cases, pathogens were mainly multiple drug-resistant organisms and tuberculosis, or fungi. We found that PCT value presented a skew distribution in disease with a median of 2.06 ng/mL. Single PCT or combination of PCT and sputum culture had similar distribution. With sputum culture as the reference, PCT sensitivity was 41.2% and specificity was 66.4%. In the cases of sputum culture aspergillus and CT suggestion of aspergillus infection, serum BG assay value distribution was similar, and the median and average were both lower than cut-off. With sputum culture as the reference, serum BG assay sensitivity was 13.2% and specificity was 84.1%. In the 12 cases with positive sputum culture and serum BG assay, serum BG assay median was 112.91 pg/mL. With CT as the reference, serum BG assay sensitivity was 21.4% and specificity was 75.0%. In the 17 cases with the same sputum and blood culture result with the PCT median of 7.51 pg/mL, there were three cases whose PCT value was under the cutoff and three cases whose serum BG assay value was above the cutoff. In evaluation of the combination of PCT and serum BG assay, the analysis had yielded that we could neither diagnose pulmonary infection with both being positive, nor exclude the disease with both being negative. ConclusionWith regard to PCT and serum BG assay, we should be prudent and wise and use it after reasonable evaluation and entire analysis.