Presepsin区分脓毒症患者G-菌与G+菌、真菌感染的价值
The value of serum presepsin in differentiating Gram-negative bacteria from Gram-positive bacteria and fungal infection in sepsis patients
目的 验证可溶性白细胞分化抗原14亚型(presepsin)能否用于区分脓毒症患者革兰氏阴性菌(G-菌)感染与革兰氏阳性菌(G+)、真菌感染.方法 采用前瞻性研究方法,收集于2017年6月至2018年11月重症监护病房(ICUs)细菌或真菌培养阳性的脓毒症患者,根据培养结果分为G-菌组、G+菌组和真菌组.入院时取外周血检测presepsin和降钙素素原(PCT)水平.结果 (1)共156例患者纳入研究,96例(62%)患者G-菌感染,25例(16%)患者G+菌感染,35例(22%)患者真菌感染;(2)G-菌组presepsin水平明显高于G+菌组(P=0.005)和真菌组(P=0.000);(3)ROC曲线下面积(AUC)比较,presepsin区分G-菌感染与G+菌、真菌感染明显优于PCT(AUC:0.809 vs 0.712,P=0.024),presepsin联合PCT后区分G-菌感染与G+菌、真菌感染明显优于单独presepsin (AUC:0.866 vs 0.809,P=0.041).结论 与PCT相比,presepsin可更好地用于区分脓毒症患者G-菌与G+菌、真菌感染.
更多Objective To examine whether presepsin level can serve as a distinguishing marker between G-bacteria and G+ bacteria,fungal infection in sepsis patients.Methods A prospective observation study was conducted on the consecutive patients with positive bacterial cultures in intensive care unit (ICU) from June 2017 to November 2018.The patients were divided into the G-group,G+ group and fungal group.Blood samples were collected upon admission to measure the levels of presepsin and procalcitonin (PCT).Results (1) Of the 156 patients met the inclusion criteria.96 (62% G-rods,25 (16%) G+ microbes,and 35 (22%) fungi were detected.(2) Presepsin concentrations were significantly higher in the G-group compared with the G+ and fungal groups (P =0.000).(3) Presepsin level has a higher accuracy in differentiating G-sepsis from Gram+ and fungal sepsis than PCT level [area under the curve (AUC):0.809 vs 0.712].The AUC value of a combination of presepsin and PCT level was significantly larger than that of presepsin level alone in differentiating G-sepsis from Gram+ and fungal sepsis (AUC:0.866 vs 0.809).Conclusions In contrast to PCT,presepsin is a good discriminative biomarker in different infections.
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