Application Of Serum PCT And STREM-1 In Infectious Diseases

Objective:Of this study was to explore the Procalcitonin?PCT?,Soluble triggering receptor expressedonmyeloid cells-1?sTREM-1?and traditional infection markers in the Bloodstream infections?BSI?diagnosis and clinical value to distinguish the pathogenic bacteria types,in order to assist clinical diagnosis,timely implementation of the corresponding antibiotic treatment,improve the prognosis of patients.Methods:A total of 187 patients with non-chronic kidney disease?BSI?confirmed by blood culture from December 2018 to November 2019 were selected,including 116patients with G^-bacteria,43 patients with G⁺bacteria and 28 patients with fungus.Meanwhile,selected 50 cases of the same period the Nonbloodstream infection?NBSI?patients as control group.A total of 48 patients?21 patients with G⁺bacteria and 27patients with G^-bacteria?had chronic kidney disease?BSI?,and 26 patients with NBSI at the same time were selected as the control group.50 healthy subjects were selected as the control group.The levels of PCT,strem-1 and traditional infection markers in BSI group,NBSI group and healthy control group,as well as G⁺bacteria,G^-bacteria and fungal infections in each group were compared.Results:1.In the non-chronic kidney disease group,except for WBC,PCT,sTREM-1,CRP and NEU%of BSI patients showed a significantly increased trend compared with those of NBSI patients?P<0.05?.In the group of chronic kidney disease,the levels of PCT,sTREM-1 and NEU%in BSI patients all showed an obvious increasing trend compared with those in NBSI patients?P<0.05?.The 5 indexes of BSI and NBSI patients in the above two groups were higher than those in the healthy control group?P<0.05?.2.ROC curve analysis of the above detection indicators showed that the diagnostic efficacy of BSI in patients with non-chronic kidney disease was PCT,strem-1,CRP and NEU%from high to low.The diagnostic efficacy of BSI in patients with chronic kidney disease was sTREM-1,PCT,and NEU%.3.In the non-chronic kidney disease BSI group,the levels of PCT after G^-bacteria infection were significantly higher than that of G⁺bacteria?P<0.05?.With8.14ng/ml as the critical value and AUC_?PCT?as 0.642,the sensitivity and specificity of G^-pathogenic bacteria were 40.9%and 84.1%respectively.After g-bacteria infection,PCT and CRP levels were significantly higher than those of fungi?P<0.05?,with 2.13ng/ml as the critical value and AUC_?PCT?as 0.840.The sensitivity and specificity of G^-pathogen identification were 59.8%and 95.2%respectively.With78.45mg/l as the critical value,the AUC_?CRP?was 0.680,and the sensitivity of G^-pathogen identification was higher?65.7%?and the specificity was lower?71.4%?than PCT.After G⁺infection,the WBC level showed an obvious increasing trend compared with that of fungal infection,and the sensitivity and specificity of G⁺bacteria were 60.5%and 74.1%respectively,with the critical value of 10.85×10⁹/L.In the BSI group of chronic kidney disease,the PCT level after G^-bacterial infection showed a significant increase compared with that after G⁺bacterial infection?P<0.05?.With 21.90ng/ml as the critical value,the AUC_?PCT?was 0.873,and the sensitivity and specificity of G^-pathogenic bacteria were 77.8%and 85.7%respectively.4.Distribution of major pathogenic bacteria:in the BSI group of non-chronic kidney disease,G^-bacteria accounted for 62.03%,G⁺bacteria accounted for 23.00%,and fungi accounted for 14.97%.E.coli accounted for 25.67%and klebsiella pneumoniae accounted for 13.37%of G^-bacteria.Among G⁺bacteria,staphylococcus aureus accounted for 4.28%,enterococcus faecae accounted for 3.74%.Candida albicans accounted for 4.81%of the fungus.In the BSI group of chronic kidney disease,G^-bacteria accounted for 56.25%and G⁺bacteria 43.75%.E.coli accounted for 40.74%in G^-bacteria and staphylococcus aureus accounted for 66.67%in G⁺bacteria.Conclusion:1.Serum PCT levels were negatively correlated with eGFR.2.PCT,sTREM-1,NEU%and CRP have important diagnostic significance in the prediction of BSI.3.PCT was significantly increased during G^-bacterial infection.Whether accompanied by renal insufficiency or not,PCT has important significance in distinguishing G⁺bacteria from G^-bacteria,G^-bacteria and fungi,and there is no significant difference between G⁺bacteria and fungi.sTREM-1 cannot distinguish between G⁺,G^-,and fungal infections.