摘要
目的针对发热门诊疑似脓毒症人群,分析血浆可溶性白细胞分化抗原14亚型(sCD14-ST,即Presepsin)对脓毒症的早期诊断价值。方法采用前瞻性观察性研究方法,选择2022年4月至12月北京朝阳医院发热门诊收治的患者作为研究对象。对符合入组条件的患者在发热门诊就诊时实时评估序贯器官衰竭评分(SOFA),根据SOFA评分将患者分为低SOFA评分组(≤3分)和高SOFA评分组(>3分)。患者就诊时取肘静脉血,采用化学发光酶联免疫测定法检测血浆Presepsin水平;采用酶联免疫荧光法检测血浆降钙素原(PCT)水平;采用散射比浊法检测C-反应蛋白(CRP)水平;应用全自动血细胞分析仪检测白细胞计数(WBC)及中性粒细胞计数(NEUT);就诊时伴有畏寒、寒颤的患者,取肘静脉血进行血培养。比较两组患者各项炎症标志物的差异;采用二分类多因素Logistic回归分析在发热门诊疑似脓毒症患者中筛选脓毒症的早期危险因素;绘制受试者工作特征曲线(ROC曲线),探讨Presepsin和其他炎症标志物在发热门诊疑似脓毒症患者中对脓毒症的早期诊断价值,并分析其最佳截断值。结果最终纳入149例发热门诊疑似脓毒症患者,其中低SOFA评分组92例,高SOFA评分组57例。高SOFA评分组患者血浆PCT和Presepsin水平均明显高于低SOFA评分组〔PCT(μg/L):0.77(0.18,2.02)比0.22(0.09,0.71),Presepsin(ng/L):1129.00(785.50,1766.50)比563.00(460.50,772.25),均P<0.01〕;而高SOFA评分组与低SOFA评分组WBC、NEUT、CRP、血培养阳性率差异无统计学意义〔WBC(×10^(9)/L):11.32±5.47比11.14±5.29,NEUT(×10^(9)/L):9.88±4.89比9.60±5.10,CRP(mg/L):54.05(15.95,128.90)比46.11(19.60,104.60),血培养阳性率:42.3%(11/26)比29.4%(10/34),均P>0.05〕。多因素Logistic回归分析显示,Presepsin是发热门诊疑似脓毒症患者发生脓毒症的早期危险因素〔优势比(OR)=16.96,95%可信区间(95%CI)为6.35~45.29,P=0.000〕。ROC曲线分析显示,Presepsin对脓毒症的早期诊断价值明显优于WBC、NEUT、CRP、PCT、血培养〔ROC曲线下面积(AUC)及其95%CI:0.832(0.771~0.899)比0.522(0.424~0.619)、0.532(0.435~0.629)、0.533(0.435~0.632)、0.664(0.574~0.753)、0.554(0.458~0.650)〕;当Presepsin的最佳截断值为646.50 ng/L时,其敏感度和阳性预测值均高于WBC、NEUT、CRP和PCT(敏感度:89.5%比38.6%、68.4%、38.6%、57.9%,阳性预测值:64.6%比44.9%、44.3%、47.8%、55.9%)。结论在发热门诊疑似脓毒症人群中,血浆PCT、Presepsin对于脓毒症均具有早期诊断价值,且Presepsin的敏感度较PCT更高,可作为脓毒症早期标志物。
Objective To analyze the early diagnostic value of plasma soluble cluster of differentiation 14 subtype(sCD14-ST,Presepsin)in sepsis in a population with suspected sepsis in fever clinic.Methods A prospective observational study was conducted.The patients admitted to the fever clinic of Beijing Chaoyang Hospital from April to December 2022 were enrolled as the study objects.According to sequential organ failure assessment(SOFA)score,the patients were divided into low SOFA score group(SOFA score≤3)and high SOFA score group(SOFA score>3).Venous blood was collected at the time of admission.The level of plasma Presepsin was detected by chemiluminescence enzyme-linked immunoassay.The level of plasma procalcitonin(PCT)was detected by enzyme-linked immunofluorescence method.The level of C-reactive protein(CRP)was detected by scattering turbidimetry.White blood cell count(WBC)and neutrophil count(NEUT)were measured by automatic blood cell analyzer.For patients with fear of cold or chills,venous blood of upper limbs was taken for blood culture at the time of admission.The differences in inflammatory biomarkers were compared between the two groups.Binary multivariate Logistic regression analysis was used to screen the early risk factors of sepsis in fever outpatients with suspected sepsis.Receiver operator characteristic curve(ROC curve)was drawn to investigate the early diagnostic value of Presepsin and other inflammatory markers in sepsis,and to analyze the optimal cut-off value.Results A total of 149 fever outpatients with suspected sepsis were enrolled,including 92 patients with low SOFA score and 57 patients with high SOFA score.Plasma PCT and Presepsin levels in the high SOFA score group were significantly higher than those in the low SOFA score group[PCT(μg/L):0.77(0.18,2.02)vs.0.22(0.09,0.71),Presepsin(ng/L):1129.00(785.50,1766.50)vs.563.00(460.50,772.25),both P<0.01].There was no significant difference in WBC,NEUT,CRP or positive rate of blood culture between the high and low SOFA score groups[WBC(×10^(9)/L):11.32±5.47 vs.11.14±5.29,NEUT(×10^(9)/L):9.88±4.89 vs.9.60±5.10,CRP(mg/L):54.05(15.95,128.90)vs.46.11(19.60,104.60),blood culture positivity rate:42.3%(11/26)vs.29.4%(10/34),all P>0.05].Multivariate Logistic regression analysis showed that Presepsin was an early risk factor for sepsis in suspected sepsis patients in fever clinics[odds ratio(OR)=16.96,95%confidence interval(95%CI)was 6.35-45.29,P=0.000].ROC curve analysis showed that the early diagnostic value of Presepsin in sepsis was significantly better than WBC,NEUT,CRP,PCT,and blood culture[the area under the ROC curve(AUC)and 95%CI:0.832(0.771-0.899)vs.0.522(0.424-0.619),0.532(0.435-0.629),0.533(0.435-0.632),0.664(0.574-0.753),0.554(0.458-0.650)].When the optimal cut-off value of Presepsin was 646.50 ng/L,its sensitivity and positive predictive value were higher than those of WBC,NEUT,CRP,and PCT(sensitivity:89.5%vs.38.6%,68.4%,38.6%,57.9%;positive predictive value:64.6%vs.44.9%,44.3%,47.8%,55.9%).Conclusion Plasma PCT and Presepsin have early diagnostic value for sepsis in suspected sepsis patients in fever clinics,and Presepsin is more sensitive than PCT and can be used as a early marker of sepsis.
作者
宗鑫欣
刘永哲
谷丽
陈曦
杨春霞
Zong Xinxin;Liu Yongzhe;Gu Li;Chen Xi;Yang Chunxia(Department of Infectious Diseases and Clinical Microbiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing Institute of Respiratory Medicine,Beijing 100020,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2024年第4期340-344,共5页
Chinese Critical Care Medicine
基金
北京市卫生健康委员会资助项目(2021-1G-3013)。
关键词
发热门诊
疑似脓毒症
可溶性白细胞分化抗原14亚型
降钙素原
序贯器官衰竭评分
Fever clinic
Suspected sepsis
Soluble cluster of differentiation 14 subtype/Presepsin
Procalcitonin
Sequential organ failure assessment
