| IntroductionChina is such a region that with a high incidence of hepatitis B, there is a rateof7.18%in1-59years crowds who are hepatitis B surface antigen carriers[1].About93million people occured chronic HBV infection, of which in need oftreatment of active hepatitis B is about more than20million[2]. These carriers andchronic hepatitis patients may deteriorate or develop into end-stage liver disease.According to statistics,about81%of severe hepatitis cases were caused by thehepatitis B virus in our country,1%of chronic hepatitis B patients developed intosevere hepatitis each year[3].Severe hepatitis (known as liver failure domestically,fulminant hepatic failureFHF abroad) is a clinical common catastrophic syndrome, in China, the causeincludes hepatitis viruses, drug-induced, autoimmunity, toxic hepatitis etc. Thedisease with a rapid progession, a poor prognosis and a mortality ranging from60to80%, has become a serious subject in medicine.Severe hepatits patients always have various complications that cause the endto death, bacterial infection is one of the most serious. When infection is happeneddue to the hypoimmunity, it is difficult to diagnose early by clinical symptoms,physical signs, White Blood Count or temperature, because of the complicatedconditions and the concealed and atypical symptoms. Overall, the bacteriadetections are known to be the golden standard, but it is hard to do invasiveoperations to take samples due to the poor conditions of these patients, moreover,the cultures always take a pretty long time, and the positive rates are low, these donot have any benefit for the diognosis and treatments of the illnesses.As a result, to find a rapid and convenient mark which also has high specificity and sensitivity is an urgent task. During the last decade, procalcitonin has become afocus as a biomarker of bacterial (or fungal) infection. Despite extensiveinvestigation, the procalcitonin(PCT) test has not gained widespread use as adiagnostic tool in severe hepatitis patients with infection[4,5]. The aim of this study isto assess the ability of PCT,which is supposed to be helpful in the diognosis andtreatments.ObjectiveTo evaluate the clinical value of PCT in early diagnosis, differental diagnosisin pathogens and anti-infection curative effect of severe hepatitis patients withinfections.Methods102cases hospitalized in Guangzhou8th People’s Hospital from March2009to October2011were selected, of which78cases were severe hepatitis patients,24cases were chronic hepatitis B patients.The severe hepatitis Patients were stratifiedinto noninfection(27cases) and infection groups(51cases), the infection group werestratified into deterioration(32cases) and improved(19cases) subgroups accordingto the progression of the disease.Severe hepatitis was diagnosised according to the Liver Failure TreatmentGuidelines issued by the Chinese Medical Association in2006[6];Diagnosis ofchronic hepatitis B is based of the Guide to the Prevention and Treament of ChronicHepatitis B lined in2010, by the Chinese Society of Hepatology and ChineseMedical Association Infectious Diseases[3]. Exclusion criteria: prior to antibiotictreatment, age <18years, length of stay <7days, with major trauma and surgery,burns, malignancy, acute coronary syndrome, cardiogenic shock. Diagnosis ofpulmonary, intra-abdominal, biliary tract, blood, intestinal, urinary tract infectionsneeds clinical diagnosis+pathogenic culture.Patients of Severe hepatitis were examined for signs, symptoms, primarydisease and past history of chronic disease at the time of admission. Diseaseseverity scores (acute physiology and chronic health evaluation, APACHEⅡscoreand sequential organ failure assessment scoring system SOFA score)were also recorded at the same time. Infection-related signs and symptoms were recordedbefore the site of infection in infection group,5days after the use of anti-infectionas well. We tested the PCT within24hours after admission in each group, the timeof clinical diagnostic infection and5days after antibiotic treatment of infectiongroup (PCT test results:<0.5ng/ml:normal,0.5~2ng/ml:suspicious bacterial infection,2~10ng/ml: bacterial infection or systemic inflammatory response,>10ng/ml:severe sepsis). Laboratory data were collected at the same time, including:blood count, electrolytes, liver and renal functions, arterial blood gas, X-ray andB-ultrasound. Depending on the clinical symptoms,samples were collected forculture of blood and other body fluids.We compared the PCT difference amonginfection group,noninfected group and control group, the PCT levels before andafter the infection group treated with antibiotics; infected with different pathogensas well. SPSS13.0was used to analyze the results statistics.Results1. We compared general information of the infection group and thenon-infection group, inclouding age, sex, total bilirubin (TBILI), prothrombinactivity (PTA), albumin (ALB) and alanine aminotransferase (ALT), P values are0.572,0.555,0.734,0.406,0.153,0.125, respectively. There were no significantdifferences between the two groups,whose general information and evaluation offulminant hepatitis severity indicators could be compared.2. Comparison of the serum PCT results. Serum PCT levels of infected patientswith severe hepatitis was significantly higher than the non-infection group andcontrol group with chronic hepatitis B (P=0.000).3. The contrast of PCT levels between the patients with culture ofGram-negative bacteria (G-) and Gram-positive bacteria (G+), χ~2=4.363, P=0.225;The contrast of PCT levels between the patients with cultivate bacteria and fungi,χ~2=15.822, P=0.001.4. In infection group, compared the time of PCT>0.5ng/ml with culturepositive time,there was an average of3.6days in advance.5. In infection group, we compared the PCT average concentration between the first day and the fifth day of antibiotics usage, which is decreasing in the improvedsubgroup, raising in the deterioration group; In the improved subgroup,△PCTD5-D1was lower than that in the deterioration group, P <0.05.ConclusionsSerum PCT can be used as an additional indicator of early diagnosis,identifying bacterial and fungal infections,determining the anti-infective therapy ofsevere hepatitis. |
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