Lancet:降钙素原或有助于早期诊断败血症

   

    日前，在线发表于《柳叶刀·传染病学》杂志（Lancet Infectious Diseases）的一项荟萃分析表明，降钙素原（PCT）作为一种标志物，或有助于在危重病人中早期诊断败血症。当然，研究的结果还应当结合病史、体格检查和微生物学评估来仔细解读。

　　降钙素原是鉴别细菌感染的一个很有希望的标志物。研究人员评价了在危重病人中应用降钙素原诊断败血症的准确性和临床价值。

　　从开始到2012年2月21日，研究人员检索了Medline, Embase, ISI Web of Knowledge，the Cochrane Library, Scopus, BioMed Central,Science Direct和所选定的原始研究的参考文献列表。研究纳入了用英文、德语或法语发表的研究文章，这些研究应用降钙素原鉴别败血症（包括败血症、严重败血症或败血性休克）患者与那些非感染引起的全身性炎症反应综合征患者。排除标准为：针对健康人群的研究，没有感染可能的患者，小于28日龄的婴儿。两位独立的研究人员提取患者和研究的特征；通过意见达成一致来解决偏差问题。研究人员计算了个体与集合敏感性和特异性。研究人员应用I2来检测异质性并通过元回归分析来研究异质性的来源。

　　该研究返回了3487份报告，其中30份达到了纳入标准，共3244名患者。二变量分析得出的平均敏感性和特异性分别为0.77和0.79. 接受者操作特征曲线下面积为0.85.该研究具有重要的异质性（I2=96%）。所研究的亚组中的人群、入院类别、所进行的化验、疾病的严重程度与描述和参考标准的设盲，没有一项能够解释这种异质性。

来源：医学论坛网

原文链接：

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Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis

BackgroundProcalcitonin is a promising marker for identification of bacterial infections. We assessed the accuracy and clinical value of procalcitonin for diagnosis of sepsis in critically ill patients.

MethodsWe searched Medline, Embase, ISI Web of Knowledge, the Cochrane Library, Scopus, BioMed Central, and Science Direct, from inception to Feb 21, 2012, and reference lists of identified primary studies. We included articles written in English, German, or French that investigated procalcitonin for differentiation of septic patients—those with sepsis, severe sepsis, or septic shock—from those with a systemic inflammatory response syndrome of non-infectious origin. Studies of healthy people, patients without probable infection, and children younger than 28 days were excluded. Two independent investigators extracted patient and study characteristics; discrepancies were resolved by consensus. We calculated individual and pooled sensitivities and specificities. We used I[size=0.8em]2 to test heterogeneity and investigated the source of heterogeneity by metaregression.

FindingsOur search returned 3487 reports, of which 30 fulfilled the inclusion criteria, accounting for 3244 patients. Bivariate analysis yielded a mean sensitivity of 0·77 (95% CI 0·72—0·81) and specificity of 0·79 (95% CI 0·74—0·84). The area under the receiver operating characteristic curve was 0·85 (95% CI 0·81—0·88). The studies had substantial heterogeneity (I[size=0.8em]2=96%, 95% CI 94—99). None of the subgroups investigated—population, admission category, assay used, severity of disease, and description and masking of the reference standard—could account for the heterogeneity.

InterpretationProcalcitonin is a helpful biomarker for early diagnosis of sepsis in critically ill patients. Nevertheless, the results of the test must be interpreted carefully in the context of medical history, physical examination, and microbiological assessment.

FundingMinistry of Education and Research, the Deutsche Forschungsgemeinschaft, Thuringian Ministry for Education, Science and Culture, the Thuringian Foundation for Technology, Innovation and Research, and the German Sepsis Society.