Diagnostic Efficacy of Blood Inicators in the Diagnosis and Treatment of Gram-positive Cocci and Gram-negative Bacilli Infection
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摘要:
目的 探索不同血液指标单项使用、联合运用、动态监测对于细菌感染诊断、鉴别诊断、预后疗效判定的效能差异。 方法 选取玉溪市人民医院2015年1月至2022年9月有感染症状或体征,且培养为单一病原体的1843例为病例组,同期未感染者2298例为对照组,收集2组相同血液指标。变量按性别、年龄段、标本类型等进行分组。采用SPSS24.0和Medcalc20.0进行统计学处理。 结果 各血液指标单独诊断有无感染的效能AUC介于0.656~0.937,联合运用后AUC介于0.907~0.987;不同标本鉴别诊断G+c和G-b效能为血液中PCT单独运用AUC(男0.875,女0.769),而男性黏膜分泌物、无菌体液和未成年男性痰液中单独鉴别诊断效能均≤0.7,但联合运用效能分别是AUC(0.789,0.737,0.86);动态监测成年入院24 h、48 h、72 h的PCT、IL-6、CRP、WBC、LAC对G+c和G-b预后疗效,差异具有统计学意义(P < 0.05)。 结论 血液指标对细菌感染与否具有一定诊断价值,且存在性别差异,合理的联合运用效能更高;单独或联合使用血液指标对不同标本类型的G+c/G-b鉴别诊断价值不同,血液标本单项使用PCT效能最高;成年男性体表黏膜分泌物、无菌体液未成年男性痰液以联合运用模式效果最佳,女性联合使用效能均不佳;动态监测PCT、CRP、IL-6、LAC、WBC对感染预后疗效评估具有较高价值,G+c感染以24 h的IL-6、G-b感染以72 h的PCT评估效能最高。 Abstract:Objective To explore the differences in the effectiveness of using different blood indicators individually, in combination, and for dynamic monitoring in the diagnosis, differential diagnosis, and prognosis of bacterial infections. Methods 1843 cases with infectious symptoms or signs from January 2015 to September 2022 at the People’ s Hospital of Yuxi City were selected as the case group, and 2298 uninfected individuals during the same period were selected as the control group. Blood indicators of the two groups were collected. Variables were grouped according to gender, age group, specimen type, etc. SPSS 24.0 and Medcalc 20.0 were used for statistical analysis. Results The individual diagnostic efficacy of various blood indicators for detecting infection ranges from 0.656 to 0.937. When used together, the efficacy ranges from 0.907 to 0.987. The efficacy of distinguishing between G+c and G-b in different specimens is as follows: when PCT is used alone in blood, the AUC is 0.875 for males and 0.769 for females. However, the individual diagnostic efficacy in male mucous secretions, sterile body fluids, and non-adult male sputum is all ≤0.7. Yet, when used together, the efficacy is AUC(0.789, 0.737, 0.86) respectively. The dynamic monitoring of PCT, IL-6, CRP, WBC, and LAC in adult patients at 24 h, 48 h, and 72 h after admission shows statistically significant differences in prognostic efficacy for G+c and G-b(P < 0.05). Conclusions Blood indicators have a certain diagnostic value for determining whether there is a bacterial infection, and there are gender differences. The combined use of these indicators is more effective. The diagnostic value of using blood indicators alone or in combination for distinguishing between G+c and G-b in different types of specimens varies. The use of PCT alone in blood specimens is the most effective. For adult males, the combined use of body surface mucous secretions and sterile body fluids is most effective, while for underage males, the combined use of sputum is most effective. The combined use for females is not effective. Dynamic monitoring of PCT, CRP, IL-6, LAC, and WBC has a high value for evaluating the prognosis and therapeutic effect of infections. The evaluation of G+c infection is most effective at 24 hours for IL-6, and for G-b infection, it is most effective at 72 hours for PCT. -
Key words:
- Bacterial infection /
- Blood indicators /
- Difference /
- Joint detection /
- Diagnostic efficiency
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表 1 患者一般情况和临床特征
Table 1. General situation and clinical features of patients
性别、指标 成年病例组
(n = 1601)未成年病例组
(n = 242)成年对照组
(n = 1997)未成年对照组
(n = 301)性别 男 914(57.10%) 128(52.90%) 1053(52.70%) 142(47.20%) 女 687(42.90%) 114(47.10%) 944(47.30%) 159(52.80%) TP(g/L) 62.30(56.70,68.60) 57.40±8.80 71.50(68.10,75.30) 66.90(63.60,70.65) ALB(g/L) 35.51±6.84 38.90±5.50 44.80(42.40,47.20) 43.20±3.60 PA(mg/L) 162.00(107.00,220.00) 114.00(85.00,169.75) 248.00(220.00,279.00) 191.00(165.50,207.00) LAC(mmol/L) 2.50(2.00,3.20) 3.00(2.23,4.38) 1.90(1.70,2.10) 2.20(2.00,2.50) PCT(μg/L) 0.16(0.05,0.91) 0.13(0.07,0.46) 0.03(0.02,0.04) 0.04(0.03,0.05) IL-6(ng/L) 19.40(6.62,56.41) 11.15(3.17,23.88) 1.53(1.50,2.83) 1.76(1.50,4.26) CRP(mg/L) 32.31(7.19,88.07) 2.12(0.55,11.36) 1.00(0.47,1.72) 0.76(0.22,2.33) WBC(×109/L) 8.50(6.14,11.84) 9.07(6.71,11.70) 5.70(4.89,6.75) 6.56±1.86 表 2 病例组分性别比较血液指标差异性
Table 2. Gender comparison of case components and differences in blood indicators
分组 指标 男性 女性 Z P 成年组(n=1601) TP(g/L) 62.10(56.00,68.70) 62.90(57.40,68.50) −1.505 0.132 ALB(g/L) 35.80(30.60,40.90) 35.70(31.50,39.60) −1.054 0.292 PA(mg/L) 166.50(106.00,227.00) 156.00(108.00,211.00) −2.422 0.015* LAC(mmol/L) 2.60(2.10,3.20) 2.50(2.00,3.10) −2.269 0.023* PCT(μg/L) 0.18(0.06,1.04) 0.15(0.05,0.76) −1.366 0.172 IL-6(ng/L) 23.17(7.81,77.70) 14.82(5.3,41.37) −5.332 < 0.001* CRP(mg/L) 37.83(8.83,95.84) 26.93(5.48,80.39) −3.782 < 0.001* WBC(×109/L) 8.76(6.40,12.25) 8.19(5.94,11.41) −2.797 0.005* 未成年组(n=242) TP(g/L) 57.00(50.45,62.90) 57.30(50.40,65.05) −0.237 0.812 ALB(g/L) 38.90(34.70,42.95) 39.15(34.60,42.50) −0.307 0.759 PA(mg/L) 112.00(81.00,173.00) 116.50(92.50,150.25) −0.121 0.904 LAC(mmol/L) 3.45(2.40,4.88) 2.85(2.00,3.90) −2.742 0.006* PCT(μg/L) 0.16(0.08,0.59) 0.11(0.06,0.31) −2.300 0.021* IL-6(ng/L) 13.57(4.31,29.60) 7.29(2.60,19.60) −2.594 0.009* CRP(mg/L) 1.94(0.77,12.72) 2.25(0.31,8.85) −0.957 0.339 WBC(×109/L) 9.14(6.99,12.70) 8.77(6.50,11.64) −1.286 0.198 *P < 0.05。 表 3 成年组单项指标诊断有无细菌感染的效能
Table 3. Efficiency of single indicator diagnosis for bacterial infection in adult group
分组 指标 AUC 95%的置信区间 PPV(%) NPV(%) Cut-off 敏感性(%) 特异性(%) 约登指数 成年男性组
(n = 1967)TP(g/L) 0.806 0.788 ~ 0.823 100.0 72.7 63.500 56.78 100.00 0.5678 ALB(g/L) 0.879 0.863 ~ 0.893 94.7 79.0 39.800 70.46 96.58 0.6704 PA(mg/L) 0.842 0.825 ~ 0.858 86.9 74.8 203.00 64.44 91.55 0.5599 LAC(mmol/L) 0.808 0.790 ~ 0.826 100.0 77.5 2.200 66.52 100.00 0.6652 PCT(μg/L) 0.901 0.887 ~ 0.914 100.0 85.2 0.047 79.98 100.00 0.7998 IL-6(ng/L) 0.937 0.926 ~ 0.948 90.2 87.3 4.940 84.68 92.02 0.7671 CRP(mg/L) 0.937 0.925 ~ 0.947 98.1 84.0 7.150 78.34 98.77 0.7710 WBC(×109/L) 0.782 0.763 ~ 0.800 82.2 72.4 7.720 61.05 88.51 0.4956 成年女性组
(n = 1631)TP(g/L) 0.832 0.813 ~ 0.850 80.0 79.1 66.500 68.12 87.61 0.5573 ALB(g/L) 0.915 0.901 ~ 0.928 96.1 82.8 38.700 72.05 97.88 0.6993 PA(mg/L) 0.837 0.818 ~ 0.854 95.0 78.5 184.000 63.62 97.56 0.6088 LAC(mmol/L) 0.787 0.761 ~ 0.801 100.0 77.8 2.200 60.84 100.00 0.6084 PCT(μg/L) 0.904 0.888 ~ 0.918 100.0 85.7 0.047 77.00 100.0 0.7700 IL-6(ng/L) 0.905 0.890 ~ 0.919 90.7 84.5 5.170 76.27 94.28 0.7055 CRP(mg/L) 0.921 0.907 ~ 0.934 92.0 85.87 4.670 78.31 95.02 0.7333 WBC(×109/L) 0.739 0.717 ~ 0.760 71.0 74.1 7.310 60.70 81.99 0.4269 表 4 未成年单项指标诊断有无细菌感染的效能
Table 4. Effectiveness of single indicator diagnosis of bacterial infection in minors
分组 指标 AUC 95%的置信区间 PPV(%) NPV(%) Cut-off 敏感性(%) 特异性(%) 约登指数 未成年男性组
(n = 270)TP(g/L) 0.802 0.749 ~ 0.848 81.7 78.1 62.000 73.44 85.21 0.5865 ALB(g/L) 0.757 0.702 ~ 0.807 75.2 72.6 40.800 66.41 80.28 0.4669 PA(mg/L) 0.822 0.771 ~ 0.866 93.0 73.9 132.000 62.50 95.77 0.5827 LAC(mmol/L) 0.796 0.743 ~ 0.842 96.4 74.7 2.800 63.28 97.89 0.6117 PCT(μg/L) 0.924 0.886 ~ 0.953 99.1 86.5 0.059 82.81 99.30 0.8211 IL-6(ng/L) 0.842 0.793 ~ 0.883 96.5 75.1 8.670 64.06 97.89 0.6195 CRP(mg/L) 0.709 0.651 ~ 0.762 61.3 66.9 1.180 65.62 62.68 0.2830 WBC(×109/L) 0.754 0.698 ~ 0.804 76.2 69.8 8.550 60.16 83.10 0.4325 未成年女性组
(n = 273)TP(g/L) 0.809 0.757 ~ 0.854 78.2 79.7 60.800 69.30 86.16 0.5546 ALB(g/L) 0.725 0.676 ~ 0.785 64.0 74.2 40.500 64.04 74.21 0.3825 PA(mg/L) 0.872 0.824 ~ 0.907 90.3 83.3 134.00 73.68 94.34 0.6802 LAC(mmol/L) 0.700 0.641 ~ 0.754 90.3 73.2 2.800 50.00 96.23 0.4623 PCT(μg/L) 0.894 0.851 ~ 0.928 98.9 86.3 0.059 78.07 99.37 0.7744 IL-6(ng/L) 0.762 0.712 ~ 0.816 86.9 71.2 8.130 46.49 94.97 0.4146 CRP(mg/L) 0.656 0.596 ~ 0.712 75.4 67.9 5.330 40.35 90.57 0.3092 WBC(×109/L) 0.749 0.693 ~ 0.799 78.2 72.8 8.590 53.51 89.31 0.4282 表 5 成年男性组微生物感染二元Logistic回归分析结果
Table 5. Binary logistic regression analysis of microbial infections in the adult male group
分组 指标 B 标准误差 瓦尔德 显著性 Exp(B) EXP(B) 的 95% 置信区间 下限 上限 成年组男性 TP(g/L) 0.098 0.037 6.822 0.009 1.103 1.025 1.187 ALB(g/L) 0.044 0.060 0.536 0.464 1.045 0.929 1.174 PA(mg/L) 0.005 0.003 2.323 0.127 1.005 0.999 1.012 LAC(mmol/L) −4.655 0.463 100.917 0.000 0.010 0.004 0.024 PCT(μg/L) −83.791 11.474 53.329 0.000 0.000 0.000 0.000 IL-6(ng/L) −0.244 0.068 12.880 0.000 0.784 0.686 0.895 CRP(mg/L) −0.241 0.052 21.299 0.000 0.786 0.710 0.871 WBC(×109/L) −0.205 0.070 8.498 0.004 0.814 0.709 0.935 常量 7.395 2.097 12.437 0.000 1627.525 表 6 成年女性组微生物感染二元Logistic回归分析结果
Table 6. Binary logistic regression analysis results of microbial infections in adult and female groups
分组 指标 B 标准误差 瓦尔德 显著性 Exp(B) EXP(B) 的 95% 置信区间 下限 上限 成年组女性 TP(g/L) 0.001 0.033 0.002 0.967 1.001 938 1.069 ALB(g/L) 0.243 0.056 18.727 0.000 1.276 1.142 1.424 PA(mg/L) 0.012 0.004 8.757 0.003 1.012 1.004 1.020 LAC(mmol/L) −3.621 0.406 79.706 0.000 0.027 0.012 0.059 PCT(μg/L) −56.686 11.016 26.480 0.000 0.000 0.000 0.000 IL-6(ng/L) −0.238 0.068 12.464 0.000 0.788 0.690 0.899 CRP(mg/L) −0.178 0.051 12.097 0.001 0.837 0.757 0.925 WBC(×109/L) −0.050 0.063 0.627 0.428 0.952 0.842 1.076 常量 −0.630 2.229 0.080 0.777 0.533 表 7 未成年男性组微生物感染二元Logistic回归分析结果
Table 7. Binary logistic regression analysis results of microbial infection in underage male group
分组 指标 B 标准误差 瓦尔德 显著性 Exp(B) EXP(B) 的 95% 置信区间 下限 上限 未成年组男性 TP(g/L) 0.095 0.056 2.878 0.090 1.100 0.985 1.228 ALB(g/L) −0.174 0.096 3.313 0.069 0.840 0.696 1.013 PA(mg/L) −0.005 0.008 0.358 0.549 0.995 0.979 1.011 LAC(mmol/L) −2.006 0.631 10.114 0.001 0.135 0.039 0.463 PCT(μg/L) −66.359 17.253 14.794 0.000 0.000 0.000 0.000 IL-6(ng/L) −0.197 0.067 8.704 0.003 0.821 0.720 0.936 CRP(mg/L) −0.072 0.045 2.524 0.112 0.931 0.852 1.017 WBC(×109/L) 0.038 0.154 0.060 0.807 1.038 0.768 1.405 常量 12.346 3.778 10.680 0.001 230033.663 表 8 未成年女性组微生物感染二元Logistic回归分析结果
Table 8. Binary logistic regression analysis results of microbial infection in underage female group
分组 指标 B 标准误差 瓦尔德 显著性 Exp(B) EXP(B) 的 95% 置信区间 下限 上限 未成年女性组 TP(g/L) 0.209 0.072 8.385 0.004 1.233 1.070 1.420 ALB(g/L) −0.331 0.110 9.025 0.003 0.718 0.579 0.891 PA(mg/L) −0.001 0.008 0.007 0.936 0.999 0.983 1.016 LAC(mmol/L) −1.005 0.388 6.719 0.010 0.366 0.171 0.783 PCT(μg/L) −47.854 13.572 12.432 0.000 0.000 0.000 0.000 IL-6(ng/L) −0.058 0.062 0.881 0.348 0.943 0.835 1.066 CRP(mg/L) −0.292 0.083 12.211 0.000 0.747 0.634 0.880 WBC(×109/L) −0.054 0.133 0.168 0.682 0.947 0.730 1.228 常量 7.852 3.380 5.397 0.020 2569.921 表 9 联合运用诊断有无细菌感染的效能评估
Table 9. Effectiveness evaluation of combined application in diagnosis of bacterial infection
分组 血液指标联合模式 AUC PPV
(%)NPV
(%)cutoff 敏感
性(%)特异
性(%)约登
指数95%的
置信区间成年
男性组ALB+PA+LAC+PCT+IL-6+CRP+WBC联合模式
为:logitP=8.8×ALB+PA-931×LAC-16758.2×
PCT-48.8×IL-6-48.2×CRP-41×WBC0.987 98.8 94.9 −2837.97 94.09 99.05 0.9314 0.981~0.991 成年
女性组ALB+PA+LAC+PCT+IL-6+CRP
联合模式为:
logitP=20.25×ALB+PA-301.75×LAC-4723.8×
PCT-19.8×IL-6-14.8×CRP0.981 97.3 95.1 105.88 93.16 98.09 0.9125 0.973~0.987 未成年
男性组LAC+PCT+IL-6
联合模式为:logitP=10.2×LAC+
IL-6+336.8×PCT0.946 99.1 88.1 51.57 85.16 99.30 0.8445 0.912~0.970 未成年
女性组ALB+LAC+PCT+CRP联合模式为:
logitP=1.13×ALB+3.44×LAC+163.88×PCT+CRP0.907 81.4 88.4 10.18 84.21 86.16 0.7037 0.867~0.939 表 10 成年体表黏膜分泌物多项指标联合鉴别诊断G+c和G-b效能
Table 10. Efficiency of combined differential diagnosis of G+c and G-b by multiple indexes of human surface mucosal secretions
分组 血液指标联合模式 AUC PPV
(%)NPV
(%)Cut-off 敏感性
(%)特异性
(%)约登指数 95%的
置信区间成年组
男性组ALB+LAC+PCT+CRP+WBC联合模式
为:logitP=9.57×ALB-37.71×LAC+
21.5×PCT+8.29×WBC+CRP0.789 71.3 79.1 418.82 79.31 71.09 0.5040 0.733 ~ 0.839 表 11 未成年男性痰液多项指标联合运用鉴别诊断G+c和G-b效能
Table 11. efficacy of combined application of multiple indicators in sputum of underage men in differential diagnosis of G+c and G-b.
分组 血液指标联合方式 AUC PPV
(%)NPV
(%)CUTOFF 敏感性
(%)特异性
(%)约登指数 95%的
置信区间未成年
男性组TP+PA+WBC联合联合模式
为:logitP=PA+7.7×WBC0.862 70.6 93.1 219.59 85.71 84.37 0.7009 0.728 ~ 0.946 表 12 成年男性无菌体液多项指标联合运用鉴别诊断G+c和G-b效能
Table 12. efficacy of combined use of multiple indexes of sterile body fluids in differential diagnosis of G+c and G-b in adult males
分组 血液指标联合方式 AUC PPV
(%)NPV
(%)CUTOFF 敏感性
(%)特异性
(%)约登指数 95%的
置信区间成年男性组 ALB+PA联合模式为:
logitP=PA−15.4×ALB0.738 59.6 78.3 −361.94 73.68 65.45 0.3914 0.637 ~ 0.824 表 13 G+c各指标动态疗效预后效能
Table 13. Prognostic efficacy of dynamic curative effect of G+C indicators
指标 治疗
时间AUC PPV(%) NPV(%) Cut-off 敏感性(%) 特异性(%) 约登指数 95%的置信区间 PCT
(μg/L)PCT-0 0.625 75.0 62.5 7.34 50.00 83.33 0.3333 0.406 ~ 0.812 PCT-1 0.844 100.0 72.5 4.10 75.00 100.00 0.7500 0.614 ~ 0.965 PCT-2 0.841 90.0 76.9 3.54 75.00 90.91 0.6591 0.630 ~ 0.958 PCT-3 0.848 77.8 81.8 2.04 77.78 81.82 0.5960 0.619 ~ 0.967 IL-6
(ng/L)IL-6-0 0.792 68.7 87.5 70.80 91.67 58.33 0.5000 0.578 ~ 0.929 IL6-1 0.969 100.0 88.9 164.00 91.67 100.00 0.9167 0.779 ~ 1.000 IL6-2 0.964 83.3 100.0 49.79 100.00 81.82 0.8182 0.779 ~ 1.000 IL6-3 0.813 77.8 90.0 88.01 87.50 81.82 0.6932 0.570 ~ 0.952 CRP
(mg/L)CRP-2 0.755 62.5 100.0 72.60 100.00 45.45 0.4545 0.520 ~ 0.913 CRP-3 0.773 61.5 100.0 84.20 100.00 54.55 0.5455 0.526 ~ 0.930 表 14 G-b各指标动态疗效预后效能
Table 14. Prognostic efficacy of dynamic curative effect of G-B indicators
指标 治疗时间 AUC PPV(%) NPV(%) Cut-off 敏感性(%) 特异性(%) 约登指数 95%的置信区间 PCT(μg/L) PCT-0 0.670 60.0 70.6 16.80 54.55 75.00 0.2955 0.528 ~ 0.792 PCT-1 0.795 70.8 80.6 13.80 73.91 78.12 0.5204 0.664 ~ 0.892 PCT-2 0.780 73.9 80.6 9.33 73.91 80.65 0.5456 0.646 ~ 0.881 PCT-3 0.831 76.2 84.4 5.31 76.19 84.37 0.6057 0.703 ~ 0.920 IL-6 (ng/L) IL-6-0 0.660 57.1 76.0 165.00 72.73 61.29 0.3402 0.517 ~ 0.784 IL-6-1 0.667 60.9 70.0 69.00 65.22 70.00 0.3522 0.524 ~ 0.790 WBC(×109/L) WBC3 0.682 87.5 66.7 15.37 38.89 95.65 0.3454 0.519 ~ 0.819 LAC(mmol/L) LAC-1 0.668 62.5 70.6 3.20 60.00 86.67 0.4667 0.521 ~ 0.795 LAC-2 0.708 88.9 74.4 3.00 42.11 96.55 0.3866 0.559 ~ 0.830 LAC-3 0.746 77.8 75.0 2.80 52.94 100.00 0.5294 0.597 ~ 0.863 -
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