降钙素原联合C反应蛋白动态监测在恶性血液病患者感染预测模型中的临床应用价值

Clinical utility of dynamic monitoring of procalcitonin combined with C-reactive protein in the infection prediction model for patients with malignant hematological diseases

摘要:

目的 评估降钙素原（PCT）与C反应蛋白（CRP）动态监测在恶性血液病患者感染预测中的临床应用价值，并探讨其对不同病原体感染的诊断效能。方法 回顾性分析2020年6月—2024年6月南京鼓楼医院集团宿迁医院收治的102例恶性血液病合并感染患者作为感染组。感染组进一步分为细菌感染组（71例）、真菌感染组（18例）和病毒感染组（13例）。另取该院同期未感染的50例恶性血液疾病患者作为对照组。分析各组血清PCT和CRP水平差异，并通过受试者工作特征（ROC）曲线评估PCT和CRP在感染预测中的价值。结果 感染组血清PCT和CRP水平均高于对照组（P <0.05）。细菌感染组血清PCT和CRP水平均高于真菌感染组和病毒感染组（P <0.05），真菌感染组血清PCT和CRP水平均高于病毒感染组（P <0.05）。革兰阴性菌组血清PCT和CRP水平均高于革兰阳性菌组（P <0.05）。念珠菌组与曲霉菌组血清PCT和CRP水平比较，差异均无统计学意义（P >0.05）。细菌感染组PCT阳性率、CRP阳性率和联合阳性率均高于真菌感染组和病毒感染组（P <0.0125）。ROC曲线结果表明，血清PCT、CRP联合预测恶性血液病患者感染的AUC为0.947（95% CI：0.896，0.998），敏感性97.1%（95% CI：0.916，0.994），特异性94.0%（95% CI：0.835，0.987）。结论 血清PCT和CRP的表达异常与恶性血液病患者的感染风险及病原体类型紧密相关，可作为感染预测的有效生物标志物。

Abstract:

Objective To investigate the clinical value of dynamic monitoring of procalcitonin (PCT) combined with C-reactive protein (CRP) in the infection prediction model for patients with malignant hematological diseases and to analyze its diagnostic performance for different pathogens.Methods A retrospective analysis was conducted on 102 patients with malignant hematological diseases complicated by infections, who were admitted to our hospital from June 2020 to June 2024. The infection group was further divided into the bacterial infection group (n = 71), fungal infection group (n = 18), and viral infection group (n = 13). Additionally, 50 patients with malignant hematological diseases without infections in our hospital during the same period were selected as the control group. The differences in serum PCT and CRP levels among the groups were analyzed, and the predictive value of PCT and CRP for infections was evaluated using receiver operating characteristic (ROC) curves.Results The serum levels of PCT and CRP in the infection group were significantly higher than those in the control group (P < 0.05). Among infection subgroups, bacterial infections exhibited higher PCT and CRP levels than fungal and viral infections (P < 0.05), while fungal infections showed even higher levels of these two indicators than viral infections (P < 0.05). Gram-negative bacterial infections demonstrated significantly elevated PCT and CRP levels compared to Gram-positive bacterial infections (P < 0.05). No significant differences in serum PCT and CRP levels were found between Candida and Aspergillus infections as assessed by the t-test (P > 0.05). The serum PCT and CRP as well as their combined detection yielded higher positivity rates for bacterial infections than for fungal or viral infections (P < 0.0125). ROC curve analysis revealed that the AUC of the combination of serum PCT and CRP for predicting infections in patients with malignant hematological diseases was 0.947 (95% CI: 0.896, 0.998), with a sensitivity of 97.1% (95% CI: 0.916, 0.994) and a specificity of 94.0% (95% CI: 0.835, 0.987).Conclusion Abnormal serum levels of PCT and CRP are closely associated with both infection risk and pathogen type in patients with malignant hematologic diseases, rendering them effective biomarkers for infection prediction.