Objective To evaluate the value of serumprocalcitonin( PCT) guided antibiotic strategy in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) .Methods From August 2011 to June 2012, a total of 96 patients hospitalized for AECOPD were randomly assigned into a PCT-guided group( n = 48) and an empirical therapy group( n = 48) . The PCT levels of PCT-guided group were measured by immunochemiluminometric assays before and 5,7, 10 days after treatment. The PCT-guided group was treated with antibiotics according to serum PCT levels, ie. antibiotic treatment was applied when PCT level ≥ 0. 25 μg/L and was discouraged when PCT level lt; 0. 25 μg/L. The empirical therapy group received antibiotics according to physician’s decision. The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, clinical efficacy, hospital mortality, rate of invasive mechanical ventilation and costs of hospitalization were recorded. Results The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, and costs of hospitalization in the PCT-guided group were all lower than those of the empirical therapy group( P lt;0.05) while clinical efficacy, hospital mortality and rate of invasive mechanical ventilation were similar in two groups(Pgt;0.05) . Conclusion PCT guided antibiotic strategy can be used in the treatment of AECOPD, which may reduce the dose of antibiotic drugs to avoid bacterial resistance and lower costs of hospitalization.
Objective To investigate the values of pneumonia severity index ( PSI) , CURB-65,plasma procalcitonin ( PCT) , C-reactive protein ( CRP) measurements for evaluation the severity of healthcare-associated pneumonia ( HCAP) .Methods A retrospective observational study was conducted on 92 hospitalized patients with HCAP admitted between June 2010 and December 2011. They were divided into different groups according to different severity assessment criteria. The variance and correlation of PCT,CRP,WBC and percent of neutrophil ( Neu% ) levels were compared among different groups. ROC curvewas established to analyze PSI, CURB-65, PCT and CRP levels for predicting the motality of HCAP patients.Results In the severe HCAP group, PSI and CURB-65 scoring and serum PCT, CRP, WBC, Neu% levels were significantly higher than those in the non-severe HCAP group( P lt; 0. 05) . In the high-risk HCAP group, PCT, CRP, WBC and Neu% levels were significantly higher than those in the low-risk HCAP group according to the PSI and CURB-65 scoring criteria( P lt;0. 05) .WBC and Neu% levels were also significantly higher than those in the moderate-risk group. PSI and CURB-65 scoring were positively correlated with PCT and CRP levels. PSI scoring gt;120 points or CURB-65 scoring gt;2 points on admission were predictors of mortality. Conclusions PSI and CURB-65 scoring are correlated with severity of HCAP. Combining serum PCT and CRP levels can improve the predictive accuracy of the severity of HCAP.
ObjectiveTo investigate the role of dynamic monitoring procalcitonin (PCT) in the comprehensive evaluation during the diagnosis and treatment of community acquired pneumonia (CAP). MethodsFour hundred and sixty-eight patients with CAP were randomly assigned to a PCT-guided group (the research group) and a standard guideline group (the control group). The clinical symptoms,CURB-65 grade,blood leucocyte count and classification,and C-reactive protein (CRP)were compared between two groups. The PCT-guided application time of antibiotics,the hospitalization time,chest CT examination rate,the cure or the improvement rate were also estimated and commpared. ResultsThe hospitalization time [(9.6±1.7)days vs. (10.9±1.6)days],hospitalization cost [(6 957.11±1 009.46) yuan vs. (8 011.35±1 049.77) yuan],chest CT examination rate (56.96% vs. 89.40%),the application time of antibiotics [(16.5±2.3)days vs. (20.0±1.2)days],and the rate of required antibiotics upgrade (6.96% vs. 11.06%) in the research group were all significantly lower than the control group (P<0.05). There was no significant difference between two groups in the ratio of the adverse reaction of antibiotics (14.78% vs. 15.20%),the rate of transfer into ICU (2.61% vs. 3.69%) or the mortality (1.74% vs. 2.30%)(P>0.05). ConclusionOn the basis of CAP guidelines,the dynamic monitoring of PCT may shorten the time of antibiotic use and the hospitalization,reduce the cost of hospitalization and the rate of chest CT scan in patients with CAP.
ObjectiveTo explore the correlation of serum neutrophil gelatinase-associated lipocalin (sNGAL) with inflammatory response in patients with community-acquired pneumonia (CAP) and assess the diagnostic value of sNGAL for severe CAP (SCAP).MethodsFrom January 2018 to June 2019, a total of 85 patients with CAP were enrolled in this study. Age, length of hospital stay, the levels of serum creatinine, blood urea nitrogen, white blood cell count,C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin, and CURB-65 score were compared between patients with SCAP (n=34) and patients without SCAP (n=51). The correlations of sNGAL with serum creatinine, blood urea nitrogen, white blood cell count, CRP, IL-6, procalcitonin, and CURB-65 score were assessed with Spearman’s correlation analysis. The area under the receiver operating characteristic (ROC) curve for sNGAL diagnosing SCAP was examined. ResultsCompared with patients without SCAP, SCAP patients demonstrated older age, longer hospital stay, higher serum CRP and IL-6 concentritions, and higher CURB-65 score (P<0.05). The Spearman’s correlation test showed that sNGAL was positively correlated with serum CRP, IL-6, PCT and CURB-65 score (rs=0.472, 0.504, 0.388, and 0.405, respectively; P<0.01). According to ROC analysis, the area under curve of sNGAL for diagnosing SCAP were 0.816, with a sensitivity of 76.56% and a specificity of 74.4% when the cut-off value was 171.0 ng/mL.ConclusionssNGAL concentration is positively correlated with the serverity of CAP. It can be regarded as a reliable indicator for diagnosis of SCAP in patients with CAP.
Objective To evaluate the effects and safety of procalcitonin(PCT)-guided algorithms of antibiotic therapy in critically ill patients in intensive care unit (ICU). Methods Literatures in English and Chinese concerning randomized controlled trials(RCTs) on PCT-guided algorithms of antibiotic therapy in critically ill patients was retrieved by electronic and manual search. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. Results Eight RCTs involving 2708 ICU patients were included, with 1360 patients in the PCT-guided group and 1348 patients in the control group. Compared with the control group, PCT-guided algorithms were associated with a significant reduction in the duration of antibiotic therapy (MD -2.44 days, 95%CI -3.25 to -1.62, P < 0.00001), and the occurrence of adverse reaction of antibiotics was also lower (RR=0.74, 95%CI 0.56 to 0.97, P=0.03), however the mortality exhibited no difference between the PCT-guided group and the control group (RR=1.00, 95%CI 0.89 to 1.13, P=0.99). Conclusion PCT-guided algorithms can shorten the duration of antibiotic therapy and reduce the occurrence of adverse reaction in critically ill patients without significant effect on mortality.
ObjectiveTo systematically evaluate the efficacy and safety of procalcitonin guided algorithms of antibiotic therapy in acute exacerbation chronic obstructive pulmonary disease (AECOPD). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 6, 2016), CBM, CNKI, VIP, and WanFang Data from the date of their establishment to July 2016, to collect randomized controlled trials (RCTs) about procalcitonin guided antibiotics therapy in patients with AECOPD. References of the included literature were also searched manually for additional studies. The literature screening, data extraction and bias risk assessment of the included studies were completed by two reviewers independently. Statistical analysis was conducted using RevMan 5.2 software. ResultsA total of ten RCTs involving 1 071 patients were included. The results of meta-analysis indicated that compared with the standard treatment group, the antibiotic prescription rate (RR=0.70, 95% CI 0.55 to 0.89, P=0.004), the rate of duration of antibiotic >10 days (RR=0.38, 95% CI 0.26 to 0.56, P<0.000 01) and the superinfection rate (RR=0.23, 95% CI 0.09 to 0.58, P=0.002) were significantly lower in the procalcitonin-guided treatment group. There were no statistical differences in clinical effective rate (RR=0.98, 95% CI 0.91 to 1.06, P=0.61), hospital mortality (RR=0.84, 95% CI 0.52 to 1.73, P=0.43), and the rate of need for intensive care (RR=0.77, 95% CI 0.40 to 1.47, P=0.43). ConclusionProcalcitonin guided antibiotics therapy may reduce antibiotic exposure and superinfection rate in patients with AECOPD. In addition, due to the low methodological quality and limited quantity of the included studies, larger sample-size, and high quality RCTs are needed to verify the above conclusion.
ObjectiveTo compare the value of the acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores, the pneumonia severity index (PSI) scores), the CURB-65 scores, and serum procalcitonin (PCT) concentration in prediction of prognosis for inpatients with community-acquired pneumonia (CAP) and discuss the influence factors.MethodsRetrospective analysis was conducted based on the APACHEⅡ scores, the CURB-65 scores, the PSI scores and PCT concentration of hospitalized CAP patients admitted in the Department of Respiratory Medicine of First Hospital of Shanxi Medical University between January 2015 and December 2016, and within 24 hours of their admission. The end point of this study was the clinical outcome of hospitalization (recovery, improvement, exacerbation or death). Receiver operating characteristic (ROC) curve analysis and binary logistic regression models were used to assess the ability of prognostic evaluation and determine the boundary value, to screen risk factors that influence deterioration and death in CAP patients.ResultsTwo hundred and thirty-five CAP patients were enrolled with 146 males and 89 females at an average age of (60.4±18.1) years old. All patients were divided into 2 groups: improving recovery group had 205 cases, and deteriorating group had 30 cases. The rank of areas under the ROC curve for predicting the deterioration and death risk of CAP, from big to small were APACHEⅡ(0.889), PSI (0.850), CURB-65 (0.789), and PCT (0.720). APACHEⅡ score over 11 points and PSI score over 91 points were optimal cut-off values for the prognostic assessment. Moreover, the logistic regression analysis revealed that APACHEⅡ score and PCT were independent risk factors of deterioration and death in CAP patients.ConclusionsThe better predictability of clinic outcome of CAP is APACHEⅡ score, PSI score, CURB-65 score, and PCT respectively in order, while the APACHEⅡ score and PCT concentration were independent risk factors for exacerbation and mortality in CAP patients. The predictive ability of a single PCT measurement is limited. The combination of APACHEⅡ score and PCT may increase specificity, but reduce sensitivity.
ObjectiveTo assess the diagnostic value of procalcitonin (PCT) and/or (1,3)-β-D-glucan test (serum BG assay) for pulmonary infection. MethodsWe collected 1 027 cases randomly from January 24th, 2013 to January 25th, 2014. First, we accumulated isolates from these cases in sputum culture. Second, we compared PCT and sputum culture, serum BG assay and sputum culture, CT and serum BG assay. Then we accumulated these PCT and studied its distribution when PCT>0.5 ng/mL and when their sputum culture was positive. We also accumulated these serum BG assay results and studied its distribution when their sputum culture was positive for aspergillus or suggested aspergillus infection by CT. Finally, we estimated the significance of the combined use of PCT and serum BG assay for diagnosis of pulmonary infection. ResultsIn these cases, pathogens were mainly multiple drug-resistant organisms and tuberculosis, or fungi. We found that PCT value presented a skew distribution in disease with a median of 2.06 ng/mL. Single PCT or combination of PCT and sputum culture had similar distribution. With sputum culture as the reference, PCT sensitivity was 41.2% and specificity was 66.4%. In the cases of sputum culture aspergillus and CT suggestion of aspergillus infection, serum BG assay value distribution was similar, and the median and average were both lower than cut-off. With sputum culture as the reference, serum BG assay sensitivity was 13.2% and specificity was 84.1%. In the 12 cases with positive sputum culture and serum BG assay, serum BG assay median was 112.91 pg/mL. With CT as the reference, serum BG assay sensitivity was 21.4% and specificity was 75.0%. In the 17 cases with the same sputum and blood culture result with the PCT median of 7.51 pg/mL, there were three cases whose PCT value was under the cutoff and three cases whose serum BG assay value was above the cutoff. In evaluation of the combination of PCT and serum BG assay, the analysis had yielded that we could neither diagnose pulmonary infection with both being positive, nor exclude the disease with both being negative. ConclusionWith regard to PCT and serum BG assay, we should be prudent and wise and use it after reasonable evaluation and entire analysis.
ObjectiveTo compare and evaluate the diagnostic value of procalcitonin(PCT) and soluble triggering receptor expressed on myeloid cells-1(sTREM-1) for ventilator-associated pneumonia(VAP). MethodsThe related studies were systematically searched in PubMed, OvidSP (EMBASE), Cochrane Library, clinicaltrials.gov, EBSCO, CBM, CNKI and Wanfang database and the methodological quality of all eligible studies were assessed using the Quality Assessment for Studies of Diagnostic Accuracy (QUADAS) tool. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and areas under the summary receiver operating characteristic (sROC) curve of PCT and sTREM-1 were pooled by Meta-disc software, respectively. Area under the sROC curve (AUC) was compared using Z-test. In addition, Bayes's theorem was used to calculate the probability of VAP, conditioned by the likelihood ratio as a function of the pretest probability. ResultsIn total, 31 studies were included (20 studies on PCT and 11 studies on sTREM-1). The combined sensitivity, specificity, DOR and AUC of diagnosing VAP by PCT was 0.78, 0.74, 15.21, and 0.868, respectively. And the combined sensitivity, specificity, DOR and AUC of diagnosing VAP by sTREM-1 was 0.88, 0.80, 30.28, and 0.919, respectively. There was no statistical difference between two areas under the sROC curve (P=0.25). ConclusionsTREM-1 is superior to PCT in diagnosing VAP, however, neither can confirm nor exclude VAP alone.
Objective To assess the value of procalcitonin ( PCT) in serum and percentage of infected cells ( PIC) in bronchoalveolar lavage fluid ( BALF) for the diagnosis of early ventilator-associatedpneumonia ( VAP) .Methods A prospective observational study was conducted in a teaching hospital. The patients consecutively admitted to the intensive care unit from January 2011 to June 2012, who received mechanical ventilation for more than 48h and clinically suspected for VAP, were recruited in the study.Patients with infection outside the lungs and previous diagnosed infection were excluded. PCT was detected and bronchoalveolar lavage was performed in the day when VAP was diagnosed. BALF cells were stained by May-Grunwald Giemsa ( MGG) for counting 100 phagocytic cells and calculating infected cells ( ICs )percentage.Results 76 of all 421 patients were enrolled in this study, 64 of which were diagnosed, 12 were under-diagnosed. The PCT [ ( 3. 48 ±1. 46) ng/mL vs. ( 1. 53 ±0. 60) ng/mL] and PIC [ ( 3. 11 ±1. 47) % vs. ( 1. 08 ±0. 29) % ] were significant higher in the patients with VAP. The threshold of 2 ng/mL of PCT and 2% of PIC corresponded to sensitivity of 78. 12% and 78. 12% , and specificity of 75. 00% and 91. 67% , respectively. The area under the receiver operating characteristic ( ROC) curve was 0. 87 ( 95% CI 78. 9%-95. 9% ) and 0. 874 ( 95% CI 79. 2% -94. 9% ) , respectively. The area under ROC curve was 0. 979, and the sensitivity was 97. 36% , specificity was 97. 36% when the two cutoff values were both achieved. Conclusion PCT and PIC are useful markers to diagnose early VAP quickly and conveniently and allow early antibiotic treatment of patients with suspected VAP.