摘要
目的探讨急诊科运用血清降钙素原(PCT)、C-反应蛋白(CRP)及白细胞计数(WBC)对鉴别急诊血流感染的价值。方法回顾性分析北京积水潭医院急诊科2017年1月至2017年12月诊断为血流感染,血培养阳性,并同时检测PCT、CRP、血常规等指标的102例患者的临床资料。对PCT、CRP、WBC在革兰阴性菌(G^-)组、革兰阳性菌(G^+)组的测定结果进行统计学分析,并运用ROC曲线评价以上指标对不同菌种的鉴别价值。结果运用ROC曲线分析,PCT水平4.28 ng/mL时,鉴别G^-菌和G^+菌的敏感度、特异度、阳性预测值和阴性预测值分别为53%、86%、75.9%和52.6%。 CRP水平96.5 mg/L时,鉴别G^-菌和G^+菌的敏感度、特异度、阳性预测值和阴性预测值分别为44%、86%、88.9%和39.4%。WBC鉴别G^-菌和G^+菌的ROC曲线下面积(AUC)值较低为0.445,对两者的鉴别价值较小。三项联合鉴别G^-菌和G^+菌的AUC为0.770。结论 G^-菌所致的血流感染中,血清PCT水平显著高于G^+菌所致血流感染(P<0.05),血清PCT水平对鉴别G^-菌和G^+菌所致急诊血流感染具有预测价值。可在急诊血流感染早期为急诊医师选择抗菌药物提供参考。
Objective To study the value of serum procalcitonin (PCT),C-reactive protein (CRP) and white blood cell count (WBC) in the identification of emergency bloodstream infection.Methods We retrospectively analyzed the clinical data of 102 patients in the emergency department of Beijing Jishuitan Hospital from January 2017 to December 2017,including the diagnosis of blood flow infection,positive blood culture,and PCT,CRP,blood routine and other biomarkers.The determination results of PCT,CRP and WBC in Gram-negative bacteria group and Gram-positive bacteria group were analyzed statistically,and ROC curve was used to evaluate the differential value of the above biomarkers to different strains.Results Using ROC curve analysis,the sensitivity,specificity,positive predictors and negative predictors of Gram-negative bacteria and Gram-positive bacteria were 53%,86%,75.9% and 52.6%,respectively,when the PCT level was 4.28 ng/mL.When CRP level was 96.5 mg/L,the sensitivity,specificity,positive predictors and negative predictors of Gram-negative bacteria and Gram-positive bacteria were 44%,86%,88.9% and 39.4%,respectively.The area (AUC) value of the ROC curve of WBC in the identification of Gram-negative bacteria and Gram-positive bacteria was lower than 0.445 ,and the differential value of the two was less.AUC which combined PCT,CRP and WBC to identification of Gram-negative bacteria and Gram-positive bacteria was 0.770.Conclusion In the bloodstream infection caused by Gram-negative bacteria,the serum PCT level was significantly higher than that caused by Gram-positive bacteria (P<0.05),and the serum PCT level had predictive value for the identification of emergency bloodstream infection caused by Gram-negative bacteria and Gram-positive bacteria.It can provide the references for emergency physicians to choose antibiotics at the early stage of emergency bloodstream infection.
作者
刘妍
崔北辰
皮春梅
王聪
赵斌
Liu Yan;Cui Bei-chen;Pi Chun-mei;Wang Cong;Zhao Bin(Department of Emergency,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2019年第6期583-586,共4页
Chinese Journal of Critical Care Medicine
