动脉血乳酸和C-反应蛋白对重症肺炎预后的评估价值

目的探讨C-反应蛋白和动脉血乳酸在重症肺炎患者预后评价中的价值。方法分析我院重症医学科住院的重症肺炎患者的临床资料。结果 70例患者被纳入本研究,死亡28例,好转42例。C-反应蛋白的ROC曲线下面积0.718(95%可信区间:0.599～0.836,P=0.005),C-反应蛋白9 mg/dl时Youden指数最大,为0.464。动脉血乳酸的ROC曲线下面积0.699(95%可信区间:0.573～0.825,P=0.005),血乳酸2.4mmol/L时Youden指数最大,为0.333。Logistc回归分析显示:血乳酸>2.4 mmol/L死亡风险上升(OR 3.333;95%CI 0.226～49.093);C反应蛋白>9 mg/dl死亡风险更高(OR 9.0;95%CI 1.628～49.756);C反应蛋白>9 mg/dl同时血乳酸>2.4 mmol/L死亡风险最高(OR 17.778;95%CI 3.356～94.179)结论 C-反应蛋白和动脉血乳酸同时升高的重症肺炎患者较单独一项升高的患者有更高的死亡风险。

Evaluation of arterial blood lactate and CRP in the prognostic assessment of patients with severe pneumonia

Objective To explore the value of arterial blood lactate and CRP in prognostic assessment of patients with severe pneumonia. Methods The clinical data of 70 cases of severe pneumonia were retrospectively analyzed. Results 42 of the 70 patients enrolled were survived and 28 deaths reported. The area under the ROC curve of CRP was 0. 718, and Youden index reached the climax （0. 464） when the level of CRP was 9 mg/dl. The area under the ROC curve of arterial blood lactate was 0. 699, and Youden index reached its max （0. 333 ） when the level of lactate was 2. 4 mmol/L. The Logistic regression analysis showed that patients had the highest risk of death when the level of lactate was higher than or equal to 2.4 mmoL/L and the level of CRP was higher than or equal to 9mg/dL. Conclusion The t3atients with severe pneumonia have a higher risk of death with both CRP level and lactate level increase.