官微以推荐-常规降钙素原筛查可减少脓毒症患者住院时间及费用

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常规降钙素原筛查可减少脓毒症患者住院时间及费用

翻译：潘红平  审核：刘金淑、陈志锦

（SIFIC热点团队）

脓毒症治疗费用是美国医院中最大的一笔支出，每年超过200亿美元。脓毒症不仅造成巨大的经济负担，还增加了人力成本。脓毒症是一种危险疾病，且经常致死，美国每年有超过一百万人感染，并且感染病例持续增加。美国《胸科杂志》（1月刊）发表的最新研究，探讨了降钙素原检测是否更有助于脓毒症的治疗。研究人员发现，在入住ICU第一天使用降钙素原筛查，能明显缩短住院时间，从整体上降低治疗费用。

目前，还没有一个用来确定患者是否患有脓毒症的“黄金标准”，因此该病对于医师来说是一项诊断挑战。不正确的脓毒症诊断，及使用不必要的抗菌药物，必然导致患者不良后果，包括延长住院时间，增加艰难梭菌感染风险，以及高于必要的医疗费用。为了寻找诊断脓毒症的新方法，降钙素原筛查作为一种可行的筛查工具，最近势头凸显。降钙素原是降钙素的前体。

芝加哥拉什大学医学中心、拉什医学院医学中心重症监护医学部主任，医学教授，首席研究员鲍克博士指出：“尽管在2012年的《拯救脓毒症指南》中指出降钙素原作为脓毒症诊断的标准之一，但降钙素原的检测并没有被统一采用，部分是因为出于成本考虑。此项研究显示，在入住ICU第一天使用降钙素原检测，能显著减少住院时间及ICU住留时间。当成年危重患者入住ICU第一天使用降钙素原检测，其住院总费用、ICU费用以及药品费用也存在显著差异。

对来源于最初医疗数据库中的15,041,827例患者进行了回顾性研究，其中730,088例患者在出院或入院时有潜在性脓毒症、全身炎症反应综合征、脓毒症或休克相关诊断。所有纳入研究的患者年龄均在18岁或以上，并且入住过ICU，按照第一天入住ICU是否接受降钙素原筛查将他们分为两组。研究者发现第一天就进行降钙素原指导治疗的患者会产生许多良好结局，包括显著缩短住院时间以及ICU住留时间，并显著降低住院总费用、食宿费用、药品费用以及抗菌药物费用。研究者们还发现，进行降钙素原检测的患者中，尽管在检验费用中会略有增加，但抗菌药物使用率会有所降低，并且他们被转移到急重症科、专科、中长期治疗科室的几率要小得多。

事实上，研究显示，患者入住ICU第一天接受降钙素原检测与未进行检测的患者相比，缩短平均住院日1.2倍，平均节省了2,759美元的住院费用。

鲍克博士指出：“这项研究很重要，它验证了依据FDA发布的指南，而进行降钙素原检测对于危重患者的影响结果是有利的。此项研究对象数量庞大，且极其多样化，所以通过近三年半的时间对众多学术和非学术医疗机构对降钙素的应用进行了评估，证实了患者入住ICU时进行降钙素原检测与其住院费用节省之间相关的真实性。”

通过最新的分析显示，入住ICU第一天进行降钙素原筛查看来已经成为一项大有前景的诊断工具，可用于缩短住院时间，同时使脓毒症的治疗更具成本效益。由于一经诊断立即实施适当的治疗，脓毒症患者的早期识别有助于预防不良后果。

来源：爱思唯尔健康科学

原文

Routine Procalcitonin Screening Reduces Hospital Stays and Costs for Sepsis Patients

Each year, more than $20 billion is spent on sepsis care, making it the most expensive condition managed in U.S. hospitals. Sepsis does not only carry a heavy economic cost, but a human one as well. A dangerous and often deadly condition, sepsis affects more than a million Americans every year and the cases continue to increase. A new study in the January issue of CHEST examines whether procalcitonin (PCT) testing helps to more effectively manage sepsis care. Investigators found that the use of PCT screening on the first day of ICU admission was linked to significantly shorter hospital stays, as well as an overall decrease in cost of care.

Currently, there is not an accepted "gold standard" test for determining whether a patient has sepsis, so the disease presents a diagnostic challenge for practitioners. An incorrect sepsis diagnosis can result in poor patient outcomes linked to the unnecessary use of antibiotics, including increased length of hospital stay, Clostridium difficile infections, and higher than necessary health care costs. In an effort to find novel approaches to diagnosing sepsis, PCT screening has recently gained momentum as a viable screening tool. PCT is a precursor of calcitonin.

"Despite the emergence of PCT as a diagnostic criterion for sepsis in the 2012 Surviving Sepsis Guidelines, PCT testing has not been uniformly adopted, in part because of cost considerations," explained lead investigator Robert A. Balk, MD, J. Bailey Carter, MD, professor of medicine, and director of the Division of Pulmonary and Critical Care Medicine, Rush Medical College and Rush University Medical Centerin Chicago. "This study demonstrated that the use of PCT testing on the first day of ICU care was associated with significantly lower hospital and ICU length of stay. There was also a significant difference in the total hospital, ICU and pharmacy costs when day one PCT testing was used in adult critically ill patients."

The retrospective study examined 15,041,827 patient cases from the Premier Healthcare database, of whom 730,088 had a potential sepsis, SIRS, septicemia, or shock-related diagnosis on admission or discharge. All patients included in the study were 18 years of age or older and admitted to the ICU. Patients were divided into two groups by whether they had received PCT screening on their first day in the ICU or not. Investigators discovered that PCT-guided care on day one was associated with a multitude of positive outcomes including significantly shorter hospital and ICU stays and significantly decreased total hospital, room and board, pharmacy, and antibiotic costs. Despite a slight increase in laboratory costs, they also found that among the PCT patients, antibiotic exposure was lower and they were less likely to be transferred to acute care, skilled nursing, intermediate care, or long-term care facilities.

In fact, the study revealed that patients receiving PCT testing on day one of ICU admission averaged 1.2 fewer hospital days than patients who were not screened and saved an average of $2,759 on their total hospital costs.

"This study is important because it validates the ability of PCT testing to favorably impact outcomes of critically ill patients when used according to the FDA cleared guideline," said Dr. Balk. "The study population was quite large and extremely diverse. The use of procalcitonin was evaluated over nearly a 3.5-year period and in a variety of clinical settings including academic and nonacademic institutions. The cost savings were real and consequential, exceeding the potential increased costs of laboratory testing associated with PCT testing on ICU admission."

According to this new analysis, PCT screening on the first day of ICU admission seems to be a promising diagnostic tool to help shorten hospital stays, as well as helping to make sepsis treatment more cost-effective. Early identification of sepsis patients can also help combat negative outcomes since proper treatment techniques can be implemented as soon as a diagnosis is made.

"The significance and mechanisms surrounding the observed clinical outcomes warrant additional evaluation," concluded Balk.

Source: Elsevier Health Sciences

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图文编辑：宋小船

审稿：孙庆芬 赵静

齐敏克216

我们医院在判断是否为医院感染时是要参照降钙素原指标的。

冬日文竹

，在入住ICU第一天使用降钙素原筛查，能明显缩短住院时间，从整体上降低治疗费用。学习了。谢谢分享。

二道桥的羊肉串

作为单一的脓毒血症的诊断依据可以，但是如果作为所有的感染诊断标准的判断依据，就可能证据不足，需要其他条件的支持才能真正确定一个感染的病例，谢谢老师们的辛苦翻译和分享！