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Procalcitonin predicts the severity of cystic fibrosis pulmonary exacerbations and readmissions in adult patients: a prospective cohort study.

降钙素原预测成人患者囊性纤维化肺部加重和再入院的严重程度: 一项前瞻性队列研究。

  • 影响因子:1.85
  • DOI:10.1136/jim-2019-001183
  • 作者列表:"Bailey KL","Murphy PJ","Lineberry OK","Haack MR","Dickinson JD","Kalil AC
  • 发表时间:2020-01-21
Abstract

:Patients with cystic fibrosis (CF) experience multiple pulmonary exacerbations throughout their lifetime, resulting in repeated antibiotic exposure and hospital admissions. Reliable diagnostic markers to guide antibiotic treatment in patients with CF, however, are lacking. Given that the CF airway is characterized by persistent and frequent bacterial infection, our goal was to determine if procalcitonin (PCT) could be used as a severity and prognostic marker of CF exacerbation. We enrolled 40 participants at the time of diagnosis of CF pulmonary exacerbation. Inclusion criteria: age ≥19 years with exacerbation requiring antibiotics as determined by the treating physician. Exclusion criteria: antibiotics initiated more than 48 hours prior to enrollment, and pregnancy. Blood samples were collected on enrollment day and after 7-10 days of treatment. Of the 40 patients enrolled, 23 (57.5%) had detectable levels of PCT (≥0.05 ng/mL). PCT levels were significantly associated with pulmonary exacerbation scores (p=0.01) and per cent decrease in forced expiratory volume in 1 second (FEV1) (p=0.01) compared with the best in the last 12 months. Those who had worsening PCT during treatment had less improvement in FEV1 (p=0.001) and were more likely to be readmitted to the hospital sooner (p<0.0001). Likewise, those who had a detectable PCT at the time of admission were more likely to be readmitted sooner (p=0.03). PCT elevation during antibiotic treatment is associated with less improvement in FEV1 and earlier readmission. A detectable PCT level occurs only in more severe CF exacerbations. Multicenter trials are needed to confirm whether PCT may play a role in the clinical care of patients with CF.

摘要

: 囊性纤维化 (CF) 患者一生中经历多次肺部恶化,导致重复抗生素暴露和住院。然而,缺乏可靠的诊断标志物来指导 CF 患者的抗生素治疗。鉴于 CF 气道以持续和频繁的细菌感染为特征,我们的目标是确定降钙素原 (PCT) 是否可作为 CF 恶化的严重程度和预后标志物。我们在诊断 CF 肺加重期时招募了 40 名参与者。纳入标准: 年龄 ≥ 19 岁,病情加重需经治疗医师确定使用抗生素。排除标准: 在入组和怀孕前 48 小时以上开始使用抗生素。在入组日和治疗 7-10 天后采集血样。在入组的 40 例患者中,23 例 (57.5%) 具有可检测的 PCT 水平 (≥ 0.05 ng/mL)。PCT 水平与肺部加重评分 (p = 0.01) 和 1 秒用力呼气容积 (FEV1) 下降 0.01 显著相关 (p =) 与最近 12 个月最好的相比。治疗期间 PCT 恶化者 FEV1 改善较少 (p = 0.001),更有可能更快再次入院 (p<0.0001)。同样,那些在入院时检测到 PCT 的患者更有可能更快再次入院 (p = 0.03)。抗生素治疗期间 PCT 升高 与 FEV1 改善较少和较早再入院相关。可检测到的 PCT 水平仅发生在更严重的 CF 恶化中。需要多中心试验来证实 PCT 是否可能在 CF 患者的临床护理中发挥作用。

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影响因子:4.40
发表时间:2020-01-01
DOI:10.1007/s00262-019-02431-8
作者列表:["Shibaki, Ryota","Murakami, Shuji","Matsumoto, Yuji","Yoshida, Tatsuya","Goto, Yasushi","Kanda, Shintaro","Horinouchi, Hidehito","Fujiwara, Yutaka","Yamamoto, Nobuyuki","Kusumoto, Masahiko","Yamamoto, Noboru","Ohe, Yuichiro"]

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影响因子:4.04
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