중환자실 발열 환자에서 감염성과 비감염성 원인의 감별을 위한 혈청 Procalcitonin의 측정

Abstract

Background: Although fever is one of the most common and challenging problem in intensive care medicine (ICU), it is difficult to distinguish between infectious and non-infectious causes. Procalcitonin (PCT) has recently been reported to be an indicator of various infectious diseases. This study examined whether or not measuring the serum PCT level in patients with fever in the ICU can help distinguish fevers with infectious causes from those with non-infectious causes. Methods: ICU patients with fever at 38°C or over from March to August 2005 were prospectively enrolled. The cause of the fever was identified by the culture results and clinical course. The leukocytes, CRP, PCT, IL-6, and TNF-α in the fever patients with infectious and non-infectious causes were compared, and the PCT level in the patients with fever in the ICU were compared with those without fever. Results: 1) 42 patients were enrolled and 46 cases of fever were analyzed 26 cases were considered to be infectious, while 13 cases were considered to be non-infectious. 7 cases were found to have no clear causes. 2) There were no significant differences in the degree of fever, leukocytes count, CRP, IL-6, and TNF-α levels in the patients with infectious and non-infectious causes. 3) The serum PCT level was higher in those with infectious causes than in those with non-infectious causes (15.1±32.57ng/mL vs 2.68±3.63ng/mL) but there was no statistical significance (p=0.06). 4) The serum PCT level of the ICU patients with fever was significantly higher than in those without fever (10.94± 27.15ng/mL vs 0.45±0.49ng/mL) (p=0.02). Conclusion: The serum PCT cannot be used to distinguish the fever in ICU patients with infectious causes from that with non-infectious causes.