降钙素原与临床肺部感染评分对老年呼吸机相关性肺炎患者病情严重程度及预后的评估价值

目的探讨血清降钙素原(PCT)水平与临床肺部感染评分(CPIS)对老年呼吸机相关性肺炎(VAP)患者病情严重程度及预后评估的临床价值。方法回顾性分析2012年1月~2015年1月450例机械通气时间>48h的患者临床资料,其中VAP患者89例。根据VAP患者病情严重程度将其分为低危组(30例)、中危组(34例)和高危组(25例),按VAP患者临床结局将其分为存活组(68例)及死亡组(21例),采用酶联免疫吸附法(ELISA)检测各组血清PCT水平同时记录CPIS情况,分别比较各组PCT及CPIS水平的差异以及PCT与CPIS的相关性,评价血清PCT及CPIS对VAP患者病情严重程度与临床预后的评估价值。结果 VAP组患者血清PCT水平及CPIS明显高于非VAP组患者(P<0.05);低危组、中危组及高危组间血清PCT水平和CPIS的差异有统计学意义(P<0.05),其中,高危组血清PCT水平和CPIS最高,中危组次之,低危组最低(P<0.05);死亡组PCT水平及CPIS显著高于存活组(P<0.05)。相关性分析显示,血清PCT水平与CPIS呈正相关(r=0.81,P=0.00)。ROC曲线分析显示,血清PCT曲线下面积(ACU)为0.821(95%CI:0.781~0.903),其最佳工作点为1.75ng/ml,此时判断VAP患者预后不良的敏感度为80.12%及特异性为84.51%;CPIS ACU为0.827(95%CI:0.775~0.914),其最佳工作点为7.1(分),此时判断VAP患者预后不良的敏感度为85.72%及特异性为80.25%。结论老年VAP患者血清PCT水平和CPIS呈现较好的相关性,PCT水平越高,CPIS越高,患者病情越危重,预后也越差,两者联合可作为预测老年VAP患者病情严重程度及临床预后的有效指标,具有较好的临床运用价值。

Clinical Research on Procalcitonin and Clinical Pulmonary Infection Score in severity and Prognosis Estimation for Elderly Patients with Ventilator Associated Pneumonia

Objective To investigate the value of serum procalcitonin (PCT) level and clinical pulmonary infection (CPIS) in severity and prognosis estimation for elderly patients with ventilator associated pneumonia (VAP). Methods A retrospective analysis to the clinical data of 450 patients from January 2012 to January 2015 who undergone mechanical ventilation over 48 h were taken, including 89 cases of patients with VAP. According to the severity of the disease, these patients with VAP were divided into low-risk group (30 cases), moderate-risk group (34 cases) and high-risk group (25 cases). According to clinical prognosis, these patients with VAP were divided into survival (68 cases) and death groups (21 cases). Serum levels of PCT were measured by enzyme linked immunosorbent assay (ELISA), and CPIS were analyzed. The differences of serum PCT levels and CPIS were compared and correlation with CPIS were analyzed, and the relationship with severity and the prognosis of VAP were also assessed. Results The serum PCT levels and CPIS on VAP group was significantly higher than non-groups (P<0.05). The difference in serum PCT levels and CPIS scores among low-risk group, moderate-risk group and high-risk group was statistically significant, in which high-risk group was the highest, followed by moderate-risk group, and low-risk group was the lowest (P<0.05). Compared the survival group, the death group had higher serum PCT levels and CPIS (P<0.05). The PCT levels and CPIS were positive correlated (r=0.81, P=0.00). ROC curves analysis results showed that the area under curve of PCT was 0.821(95%CI:0.781~0.903), and optimal operating point (OOP) was 1.75 ng/ml, which had 80.12% sensiticity and 84.51% specificity. ACU of CPIS was 0.827(95%CI:0.775~0.914), and OOP was 7.1, which had 85.72% sensiticity and 80.25% specificity. Conclusion The serum PCT levels and CPIS showed a good correlation in elderly VAP group. When the serum PCT levels are higher, CPIS is higher, and the prognosis are worse. A combination of serum PCT levels and CPIS can be used as an effective predictor on the severity and prognosis of elderly VAP patients and have better clinical value.