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Serum procalcitonin measurement as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department

机译：血清降钙素测量作为诊断给急诊科的成年发热患者的诊断和预后标志物

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IntroductionIdentification of bacterial infections is crucial if treatment is to be initiated early and antibiotics used rationally. The primary objective of this study was to test the efficiency of procalcitonin (PCT) in identifying bacterial/parasitic episodes among febrile adult patients presenting to an emergency department. Secondary objectives were to identify clinical or biological variables associated with either bacterial/parasitic infection or critical illness.MethodsThis was a prospective, single centre, non-interventional study, conducted in the adult emergency department of an academic tertiary care hospital. We included patients with body temperature of 38.5°C or greater. A serum sample for measurement of PCT was collected in the emergency room. Patients were followed up until day 30. After reviewing the medical files, two independent experts, who were blind to the PCT results, classified each of the patients as having a bacterial/parasitic infection, viral infection, or another diagnosis.ResultsAmong 243 patients included in the study, 167 had bacterial/parasitic infections, 35 had viral infections and 41 had other diagnoses. The PCT assay, with a 0.2 μg/l cutoff value, had a sensitivity of 0.77 and a specificity of 0.59 in diagnosing bacterial/parasitic infection. Of the patients with PCT 5 μg/l or greater, 51% had critical illness (death or intensive care unit admission) as compared with 13% of patients with lower PCT values.ConclusionBearing in mind the limitations of an observational study design, the judgements of the emergency department physicians were reasonably accurate in determining the pretest probability of bacterial/parasitic infection. PCT may provide additional, valuable information on the aetiology and prognosis of infection in the emergency department.
机译：简介如果要及早开始治疗并合理使用抗生素，细菌感染的识别至关重要。这项研究的主要目的是测试降钙素（PCT）在向急诊科就诊的成年发热患者中鉴定细菌/寄生虫发作的效率。次要目的是确定与细菌/寄生虫感染或重症疾病相关的临床或生物学变量。方法这是一项前瞻性，单中心，非干预性研究，在三级学术医院的成人急诊科中进行。我们纳入了体温为38.5°C或更高的患者。在急诊室收集了用于测量PCT的血清样品。对患者进行随访直至第30天。在审查医疗文件后，两名不愿接受PCT结果的独立专家将每位患者分类为细菌/寄生虫感染，病毒感染或其他诊断。结果包括243例患者在这项研究中，有167例细菌/寄生虫感染，35例病毒感染和41例其他诊断。 PCT测定的临界值为0.2μg/ l，在诊断细菌/寄生虫感染时灵敏度为0.77，特异性为0.59。在PCT 5μg/ l或更高的患者中，有51％患有重症疾病（死亡或重症监护病房），而PCT值较低的患者为13％。结论考虑到观察性研究设计的局限性，这些判断的急诊科医师在确定细菌/寄生虫感染的检测前可能性方面相当准确。 PCT可能会提供有关急诊科感染的病因和预后的其他有价值的信息。

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