The role of change of procalcitonin in the therapeutic effect evaluation of severe bacterial pneumonia
10.3760/cma.j.issn.1009-9158.2013.07.011
- VernacularTitle:降钙素原变化率在重症细菌性肺炎疗效评估中的作用
- Author:
Yan SHI
;
Yingchun XU
;
Xi RUI
;
Wei DU
;
Yao WANG
;
Ye LIU
- Publication Type:Journal Article
- Keywords:
Pneumonia,bacterial;
Calcitonin;
Protein precursors;
Treatment outcome
- From:
Chinese Journal of Laboratory Medicine
2013;36(7):615-619
- CountryChina
- Language:Chinese
-
Abstract:
Objective The aim of this study is to define if early change ofprocalcitonin (PCT) may inform about the efficacy evaluation of severe bacterial pneumonia.Methods A prospective,single-center,observational study was conducted in patients with severe bacterial pneumonia admitted to ICU in 2010 years.PCT samples were collected in baseline,72 hours,7 days and the ending in the duration of therapy.The efficacy evaluation was assessed at the end of treatment 5 days after and divided into the efficacy group and nonefficacy group according to the guiding principle of clinical research on antibacterial drugs by the Ministry of Health.Sixty-five patients with a mean age of (62.1 ± 15.9) years were evaluated.Five patients were severe community acquired pneumonia,32 patients nosocomial pneumonia and 28 patients ventilator associated pneumonia.The clinical pulmonary infection score(CPIS) was 7.9 ± 1.8 ;APACHE Ⅱ score was 14.5 ±5.3.There were 44 patients as the efficacy group and 21 patients as the nonefficacy group.SPSS13.0 was used to analyse the results.Results The PCT levels between efficacy group and nonefficacy group were (3.83 ±2.18)vs(4.23 ±2.64) μg,/L (t =1.249,P =0.387),(2.44 ± 1.05)vs(3.48 ± 1.75) μg/L(t=-1.959,P=0.045),(1.15 ±0.87) vs (3.41 ±1.58) μg/L (t=-2.904,P=0.006),and (0.51 ±0.17) vs (2.63 ±1.08) μg/L (t=-3.772,P =0.000) in baseline,72 hours,7 days and the ending in the duration of therapy.The change of PCT within the first 72 hours were (32.5 ± 12.4)％ vs (14.5 ± 7.1) ％.The area under receiver operating characteristics curve (AUC) of prediction clinical efficacy of the change of PCT within the first 72 hours was 0.823 (P =0.002),the AUC of white blood cell,the neuter granulocyte percentage,body temperature and PCT level within 72 hours were 0.575,0.543,0.521,0.597,respectively (P ＞ 0.05).In multivariate analyses,the change of PCT ＜ 30.8％ (odds ratio,15.2,95％ confidence interval,3.3-21.7,P =0.01) was independent risk factors of effect predictor.The changes of PCT within the first 72 hours (＞30.8％) combined with CPIS(＜6) were the best performance to predict clinical efficacy with a AUC of 0.910,sensitivity of 85.2％ and specificity of 92.5％.Conclusions The change of PCT within the first 72 hours can be used early to evaluate the effect in bacterial pneumonia.Especially,combined with CPIS can further improve the prediction value.
