급성 신우신염을 가진 여성 환자에서 균혈증을 예측하기 위한 초기 혈장 프로칼시토닌, 젖산 및 C-반응성 단백질의 진단 성능 비교
Comparison of the diagnostic performance of initial serum procalcitonin, lactate, and C-reactive protein for predicting bacteremia in female patients with acute pyelonephritis
김병진, 조시온, 이재백, 진영호, 정태오, 윤재철, 박보영,
소속 상세정보
김병진 ( Kim Byoung-Jin )
전북대학교병원 응급의학과
조시온 ( Jo Si-On )
전북대학교병원 응급의학과
이재백 ( Lee Jae-Baek )
전북대학교병원 응급의학과
진영호 ( Jin Young-Ho )
전북대학교병원 응급의학과
정태오 ( Jeong Tae-Oh )
전북대학교병원 응급의학과
윤재철 ( Yoon Jae-Chol )
전북대학교병원 응급의학과
박보영 ( Park Bo-Young )
한양대학교 의과대학 의학과
KMID : 0385920190300010052
Abstract
Objective: The purpose of the present study was to compare the diagnostic performance of initial procalcitonin, lactate, and high-sensitive C-reactive protein (hsCRP) for predicting bacteremia in female patients with acute pyelonephritis (APN).
Method: We conducted a retrospective study of female APN patients who visited the emergency department (ED) at the studied hospital between January 2015 and December 2016. The main outcome was bacteremia, which was reported via the first blood culture at ED. The patient demographics, co-morbidities, physiologies, and laboratory variables including initial procalcitonin, lactate, and hsCRP levels, were collected and analyzed to identify associations with the presence of bacteremia. The area under the receiver operating curve (AUROC) and sensitivity (SE)/specificity (SP) were calculated for each variable.
Results: During the study period, 282 patients were enrolled. A total of 105 (37.2%) patients had bacteremia. Escherichia coli was the most frequent pathogen. The AUROC was 0.70 (0.63-0.76), 0.70 (0.63-0.76), and 0.56 (0.49- 0.63) for the procalcitonin, lactate, and hsCRP, respectively. At a cut-off value of 0.163 ng/mL, the procalcitonin level predicted bacteremia, with a SE /SP of 95.2%/22.6%, respectively. At a cut-off value of 0.7 mmol/L, the lactate level predicted bacteremia with a SE/SP of 96.2%/20.9%, respectively. The combination of a procalcitonin level >0.447 ng/mL or a lactate level >0.7 mmo/L was chosen, as they showed 100% SE and a 100% negative predictive value.
Conclusion: The initial serum procalcitonin and lactate levels showed similar and fair discriminative performance for predicting bacteremia in female APN patients, while the hsCRP level showed poor performance. The combination of procalcitonin and lactate (procalcitonin level≤0.447 ng/mL and lactate≤0.7 mmol/L) can be used to identify patients at low risk of bacteremia.
키워드
Procalcitonin; Lactic acid; C-reactive protein; Acute pyelonephritis; Bacteremia
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