14解立新重症感染生物标记物有无临床价值.ppt

* Predicting Severity 临床指标 Sepsis (n = 15) Severe sepsis (n = 29) Septic shock (n = 8) P值 CRP (mg/dl) 10.60 (11.50) 9.40 (14.70) 13.65 (9.48) 0.711 PCT (ng/ml) 0.21 (2.50) 1.05 (11.29) 11.78 (44.4) 0.075 SOFA评分 2.9 ± 2.1 5.9 ± 3.1 11.6 ± 2.9 0.000 Feng L, et al. PLoS ONE. 2012, 7:e38400 Zhang J, et al. BMC Infectious Diseases 2011, 11:53 结论：PCT和CRP在鉴别ICU Sepsis 患者严重程度方面有一定价值 AUC 标准误 P值 95%置信区间 下限 上限 CRP 0.6331 0.05661 0.0226 0.5221 0.7441 PCT 0.6477 0.06423 0.0240 0.5218 0.7736 SOFA 0.7007 0.05185 0.0006 0.5990 0.8023 * Predicting prognosis Variable AUC(95%CI) P-value Cut off point Sensitivity Specificity SOFA score 0.813(0.721,0.906) P0.001 4.500 0.882 0.571 APECHEⅡ 0.807(0.712,0.902) P0.001 17.50 0.911 0.595 CRP 0.569(0.438,0.701) P=0.301 13.45 0.324 0.857 PCT 0.715(0.597,0.833) P=0.001 6.280 0.559 0.810 结论：在预测ICU Sepsis患者死亡预后方面PCT有一定价值 Wang H, et al. SHOCK. 2012; 37(3):263-267 * Predicting Prognosis 结论：动态评价ICU Sepsis患者死亡预后方面PCT有一定价值，SOFA更佳 Feng L, et al. PLoS ONE. 2012, 7:e38400 Predicting Prognosis Crit Care. 2014, On peer Review The elevated PCT level was a risk factor of death * * Guiding Antibiotic Therapy Curr Opin Crit Care 2013, 19:453–460 * Guiding Antibiotic Therapy Curr Opin Crit Care 2013, 19:453–460 * Guiding Antibiotic Therapy Intensive Care Med (2012) 38:940–949 Duration of antibiotic therapy for the first episode of infection p = 0.000 * Guiding Antibiotic Therapy Intensive Care Med (2012) 38:940–949 28-days mortality p = 0.906 * Procalcitonin guided antibiotic therapy algorithms could help in reducing the duration of antimicrobial administration without having a negative impact on survival An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients Intensive Care Med (2012) 38:940–949 Guiding Antibiotic Therapy * Surviving Sepsis 2012 Use of low procalcitonin levels or similar biomarkers to assist the clinician in the discontinuation of empiric antibiotics in pa