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중환자실에 입원한 세균성 폐렴환자에서 반정량적 procalcitonin 검사의 유용성

Usefulness of Semi-quantitative Procalcitonin Assay in Critically Ill Patients with Bacterial Pneumonia

감염과화학요법 2009년 41권 6호 p.342 ~ 348
이승화, 김철홍, 우흥정, 현인규, 박선욱, 김지윤, 김영욱, 김현수,
소속 상세정보
이승화 ( Lee Seung-Hwa ) - 한림대학교 의과대학 내과학교실
김철홍 ( Kim Cheol-Hong ) - 한림대학교 의과대학 내과학교실
우흥정 ( Woo Heung-Jeong ) - 한림대학교 의과대학 내과학교실
현인규 ( Hyun In-Gyu ) - 한림대학교 의과대학 내과학교실
박선욱 ( Park Seon-Wook ) - 한림대학교 의과대학 내과학교실
김지윤 ( Kim Ji-Youn ) - 한림대학교 의과대학 내과학교실
김영욱 ( Kim Young-Wook ) - 한림대학교 의과대학 내과학교실
김현수 ( Kim Hyun-Soo ) - 한림대학교 의과대학 진단검사의학교실

Abstract


Background: In pulmonary infection, serum procalcitonin levels increase rapidly, probably in response to sepsis-related cytokine release from neuroendocrine cells of bronchial epithelium and inflammatory cells. We applied procalcitonin assay in critically ill patients with bacterial pneumonia.

Materials and Methods : Patients admitted to the intensive care unit (ICU) and show diffuse infiltrations in their chest X-ray were included. Quantitative bronchoalveolar lavage (BAL) culture (≥104 CFU/mL) was performed in all cases on the 5th day of ICU admission. We excluded patients with structural lung disease, non-infectious lung infiltrations, and atypical infections such as Mycobacterium tuberculosis, Pneumocystis jiroveci, and viruses. Serum procalcitonin levels were measured semi-quantitatively by using PCT-Q kit.

Results: A total of 28 adult patients (M:F=23:5) were included: 11 (39.3%) medically-ill patients, 7 (25%) surgically-ill patients, and 10 (35.7%) burn patients. Serum procalcitonin level was <0.5 ng/mL in half of the cases (14/28) and ≥0.5 ng/mL in the remaining half of the cases. Compared to those with serum procalcitonin level of <0.5 ng/mL, patients with serum procalcitonin level of ≥0.5 ng/mL had more frequent mechanical ventilation, higher CRP/APACHE II scores/number of organ failure (P<0.05), and showed increased tendency for death (P=0.052). Positive bacterial BAL cultures were noted in 17 cases (60.7%). Of these, 7 cases (41.2%) showed serum procalcitonin level ≥0.5 ng/mL.

Conclusions: High serum procalcitonin level seems to be closely associated with the severity and poor prognosis in critically ill patients with bacterial pneumonia. However, pneumonia could not be excluded with low level of procalcitonin among ICU patients.

키워드

Intensive care unit;Pneumonia;Procalcitonin

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