Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Measuring Serum Procalcitonin in Patients with Fever in the ICU to Differentiate Infectious Causes from Non-Infectious Causes

중환자실 발열 환자에서 감염성과 비감염성 원인의 감별을 위한 혈청 Procalcitonin의 측정

  • Kim, Ho Cheol (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Kim, Kwang Min (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Lee, Sang Min (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Lee, Seung Jun (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Ham, Hyun Seok (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Cho, Yu Ji (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Jeong, Yi Yeong (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Lee, Jong Deok (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Hwang, Young Sil (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
  • 김호철 (경상대학교 의과대학 내과학교실) ;
  • 김광민 (경상대학교 의과대학 내과학교실) ;
  • 이상민 (경상대학교 의과대학 내과학교실) ;
  • 이승준 (경상대학교 의과대학 내과학교실) ;
  • 함현석 (경상대학교 의과대학 내과학교실) ;
  • 조유지 (경상대학교 의과대학 내과학교실) ;
  • 정이영 (경상대학교 의과대학 내과학교실) ;
  • 이종덕 (경상대학교 의과대학 내과학교실) ;
  • 황영실 (경상대학교 의과대학 내과학교실)
  • Received : 2006.02.21
  • Accepted : 2006.06.29
  • Published : 2006.07.30
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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 $38^{\circ}C$ 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 $TNF-{\alpha}$ 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 $TNF-{\alpha}$ levels in the patiemts 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 ($15.1{\pm}32.57ng/mL$ vs $2.68{\pm}3.63ng/mL$) 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 ($10.94{\pm}27.15ng/mL$ vs $0.45{\pm}0.49ng/mL$) (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.

배 경 : 중환자실에서 발열은 가장 흔한 임상 상황이며 그 원인을 감염성 또는 비감염성으로 감별하는 것은 적절한 치료와 예후 측면에서 매우 중요하다. Procalcitonin(PCT)는 최근 여러 감염 질환의 뛰어난 표식자로 보고되고 있다. 연구자 등은 중환자실 발열 환자에서 혈청 PCT의 측정이 감염성과 비감염성 원인을 감별하는 데 도움이 되는지 알아보기 위해 연구를 시행하였다. 방 법 : 2005년 3월부터 8월까지 내과 중환자실에서 치료받은 환자 중 $38^{\circ}C$ 이상의 발열이 있는 환자를 대상으로 백혈구, CRP, PCT, IL-6, $TNF-{\alpha}$를 측정하였고 원인을 규명하기 위한 검사를 시행하였다. 감염성과 비감염성 원인의 감별은 배양 검사 결과와 임상적인 경과에 의존해 판단하였다. 감염성 발열 환자, 비감염성 발열 환자, 발열이 없는 중환자 및 건강 성인에서 각각의 값을 비교하였다. 결 과 : 1) 총 42명의 환자를 대상으로 46 예의 발열에 대해 평가하였다. 감염성으로 생각된 경우는 26 예, 비감염성은 13 예, 7예는 원인이 명확하지 않았다. 2) 감염성과 비감염성 원인의 발열의 정도, 백혈구 수, CRP, IL-6, $TNF-{\alpha}$는 유의한 차이가 없었다. 3) 감염성 원인과 비감염성 원인의 혈청 PCT는 각각 $15.1{\pm}32.57ng/mL$, $2.68{\pm}3.63ng/mL$로 감염성 원인이 높았으나 통계적인 유의성은 없었다(p=0.06). 4) 발열이 있는 환자의 혈청 PCT은 $10.94{\pm}27.15ng/mL$로, 발열이 없는 중환자의 $0.45{\pm}0.49ng/mL$에 비해 의미 있게 높았다(p=0.02). 결 론 : 중환자실 발열 환자에서 혈청 PCT의 측정은 감염성 원인과 비감염성 원인을 감별하는 데 도움이 되지 않을 것으로 사료된다.

Keywords

References

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