降钙素原动态监测指导脓毒症患者抗感染治疗的价值

doi:10.3969/j.issn.1006-5725.2026.14.016

Abstract

Abstract:

Objective To compare the overall efficacy of procalcitonin （PCT）-guided antimicrobial therapy with that of conventional antimicrobial therapy in patients with sepsis， and to analyze the interaction and differential benefits of the PCT-guided strategy among subgroups with different clinical characteristics， thereby providing real-world evidence for individualized clinical application. Methods A total of 515 patients with sepsis who were admitted to Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2021 to June 2024 were included in this retrospective cohort study. According to the actual monitoring and treatment strategies implemented in clinical practice， the patients were divided into a PCT-guided group （n = 245） and a conventional treatment group （n = 270）. The baseline characteristics， such as age， sex， and underlying diseases， were well-balanced between the two groups. In the PCT-guided group， the PCT levels were dynamically monitored every 24 - 48 hours for at least three times. The core antibiotic discontinuation threshold was defined as a ≥ 80% decline in the peak PCT level or two consecutive PCT values < 0.5 ng/mL， and the antimicrobial therapy was adjusted accordingly in combination with the clinical assessment. In contrast， the conventional treatment group received antibiotic adjustments based on traditional indicators and clinical experience. Subsequently， the overall core efficacy and safety outcomes were compared between the two groups. Subgroup analyses were carried out based on age， Sequential Organ Failure Assessment （SOFA） score， and the presence of diabetes mellitus. A regression model-based interaction term test was employed to examine the interaction effects of each clinical characteristic with the PCT-guided strategy. Results The PCT-guided group exhibited a significantly shorter duration of antibiotic use ［408.01 （228.06， 887.00） h vs. 579.01 （288.99， 1 290.77） h， P = 0.001］ when compared with the conventional group. The PCT level at the time of antibiotic discontinuation ［0.31 （0.09， 1.41） ng/mL vs. 0.97 （0.22， 6.04） ng/mL， P < 0.001］， antibiotic costs ［6 790.44 （2 393.00， 21 712.71） yuan vs. 12 231.96 （3 396.04， 27 211.60） yuan， P = 0.004］， and the 28-day mortality rate （16.7% vs. 28.1%， P = 0.003） were also notably lower in the PCT-guided group. No significant differences were detected between the two groups in terms of the average daily antibiotic cost or the incidence of kidney dysfunction （all P > 0.05）. Subgroup and interaction analyses indicated that there was a significant interaction between age and the PCT-guided strategy regarding antibiotic duration （P for interaction = 0.039）， and between diabetes status and the PCT-guided strategy regarding the length of hospital stay （P for interaction = 0.003）； no significant interaction was identified between the SOFA score and the PCT-guided strategy （all P for interaction > 0.05）. Conclusions Dynamic monitoring of PCT can assist in shortening the duration of antibiotic therapy， reducing medical costs， and enhancing short-term prognosis. This benefit is more pronounced in patients aged less than 65 years and without diabetes. Elderly patients and those with diabetes should undergo comprehensive clinical evaluation.

Key words: sepsis, procalcitonin, antimicrobial therapy, efficacy, subgroup interaction

CLC Number:

R631.2

Huiling LAN,Junpeng TANG,Pengfei WANG,Yihan DING,Meng HU,Tao YU,Fengqing SONG. The value of dynamic monitoring of procalcitonin in guiding anti-infective treatment for patients with sepsis[J]. The Journal of Practical Medicine, 2026, 42(14): 2632-2639.

Figures/Tables 5

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References 33

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指标	常规治疗组（n = 270）	PCT指导组（n = 245）	χ2/Z值	P值
年龄［M（P₇₅，P₂₅）/岁］	60（48，70）	62（50，74）	-1.745	0.081
男性/［例（%）］	180（66.7）	161（65.7）	0.018	0.893
既往病史/［例（%）］
高血压	79（29.3）	87（35.5）	2.022	0.155
糖尿病	66（24.4）	68（27.8）	0.571	0.450
慢性阻塞性肺病	4（1.5）	6（2.4）	0.420	0.635
肝硬化	10（3.7）	5（2.0）	1.157	0.391
慢性肾功能不全	13（4.8）	11（4.5）	0.000	1.000

指标	常规治疗组（n = 270）	PCT指导组（n = 245）	χ2/Z/t值	P值
抗菌药物使用时长/h	579.01（288.99，1 290.77）	408.01（228.06，887.00）	-3.291	0.001
停药时PCT/（ng/mL）	0.97（0.22，6.04）	0.31（0.09，1.41）	-4.892	< 0.001
28 d死亡率/［例（%）］	76（28.1）	41（16.7）	8.273	0.003
院内死亡率/［例（%）］	100（37.0）	71（29.0）	3.407	0.065
日均抗菌药物费用（x ± s）/元	1 871.39 ± 2 606.92	2 071.15 ± 6 785.75	0.449	0.654
抗菌药物费用/元	12 231.96（3 396.04，2 7211.60）	6 790.44（2 393.00，21 712.71）	-2.878	0.004

指标	常规治疗组（n = 270）	PCT指导组（n = 245）	χ2值	P值
抗感染相关肾损伤	49（18.1）	40（16.3）	0.185	0.668
AST异常	123（45.6）	107（43.7）	0.115	0.734
ALT异常	129（47.8）	94（38.4）	4.263	0.039
胆红素异常	126（46.7）	105（42.9）	0.607	0.436

亚组分类	指标	常规治疗组（n = 270）	PCT指导组（n = 245）	Z值	P值	P for interaction
年龄亚组
≥ 65岁（常规组 n = 112，PCT 组 n = 108）	抗菌药物使用时长/h	454.25（254.25，738.08）	395.01（212.51，814.52）	-0.468	0.640	0.039
≥ 65岁（常规组 n = 112，PCT 组 n = 108）	住院时间/d	18.00（10.75，27.00）	15.00（10.00，25.00）	-1.167	0.244	0.605
< 65岁（常规组 n = 158，PCT 组 n = 137）	抗菌药物使用时长/h	716.52（386.99，1 583.27）	408.06（247.00，935.00）	-3.891	< 0.001	-
< 65岁（常规组 n = 158，PCT 组 n = 137）	住院时间/d	23.00（12.25，33.50）	17.00（11.00，26.00）	-2.492	0.013	-
SOFA亚组
≥ 4分（常规组 n = 80，PCT 组 n = 61）	抗菌药物使用时长/h	584.01（277.26，1 632.26）	641.99（277.01，1 066.04）	-0.052	0.959	0.074
≥ 4分（常规组 n = 80，PCT 组 n = 61）	住院时间/d	15.50（10.00，31.00）	17.00（12.00，27.00）	-0.306	0.760	0.114
< 4分（常规组 n = 190，PCT 组 n = 184）	抗菌药物使用时长/h	577.04（297.74，1 192.14）	374.92（213.74，773.03）	-3.682	< 0.001	-
< 4分（常规组 n = 190，PCT 组 n = 184）	住院时间/d	21.00（13.00，31.00）	16.00（10.00，25.00）	-3.291	0.001	-
糖尿病亚组
合并糖尿病（常规组 n = 66，PCT 组 n = 68）	抗菌药物使用时长/h	567.98（270.76，1 400.53）	421.00（257.51，830.51）	-1.081	0.280	0.332
合并糖尿病（常规组 n = 66，PCT 组 n = 68）	住院时间/d	19.00（10.00，25.75）	19.00（11.75，25.50）	-0.954	0.340	0.003
无糖尿病（常规组 n = 204，PCT 组 n = 177）	抗菌药物使用时长/h	583.51（290.51，1 241.77）	374.02（215.02，908.01）	-3.107	0.002	-
无糖尿病（常规组 n = 204，PCT 组 n = 177）	住院时间/d	22.00（12.00，34.00）	14.00（10.00，26.00）	-4.082	< 0.001	-

The value of dynamic monitoring of procalcitonin in guiding anti-infective treatment for patients with sepsis

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