PCT水平、APACHE III及MODS评分对SIRS患者预后预测性的临床比较

Predictive Comparisons of PCT level,APACHE III Score and Multiple Organ Dysfunction Score in Systemic Inflammatory Response Syndrome Patients

目的比较PCT(前降钙素)水平、APACHEIII评分和MODS评分对SIRS(系统性炎症反应综合征)患者预后的预测能力。方法将1998年11月～2004年11月间入住我院ICU,满足SIRS标准的95例患者纳入此次研究。PCT在动脉血样本中检测,记录患者入院第1个24h后APACHEIII和MODS评分,连续2周每天记录1次或直到患者出院或死亡。将患者按预后分成两组,生存者(n=71)和非生存者(n=24)。按照PCT水平的变化结果又分为3组下降组、升高组、无变化组。结果在整个研究期间APACHEIII和MODS评分在生存者和非生存者之间都有显著区别,但是PCT在生存者和非生存者之间区别仅表现在第1到第7天,入院当天按PCT的水平所分的三组中生存者和非生存者PCT的值无显著性区别。PCT、APACHEIII评分和MODS评分第1天预测死亡率的ROC曲线下面积分别为0.690,0.915,0.913。结论PCT可以作为SIRS患者死亡率的预测因子,但是可靠性低于APACHEIII和MODS评分。

Objective To compare the predictability of PCT level,APACHE Ⅲ Score and MODS score in SIRS patients prognosis. Methods 95 patients were involved in this study who met the criteria of SIRS in ICU of our hospital from November 1998 to November 2004. The level of PCT were assayed in arterial blood sample. The APACHE Ⅲ Score and MODS score were recorded after the first 24 hours of ICU admission and then daily for two weeks or until either discharge or death. All the patients were divided into two groups, survivors （n= 71 ）and nonsurvivors （n= 24） ,in accordancewith the ICU outcome.They were also divided into three groups, declining, increasing and no change, according to the level of PCT. Results The APACHE Ⅲ Score and MODS score were dramatically different between survivors group and nonsurvivors group throughout the study period. The difference between survivors group and nonsurviors group of PCT were just found up to 7th day. PCT value of the three groups were not significantly different on the first day between survivors group and nonsurviors group. The ROC curves for prediction of mortality by PCT, APACHE Ⅲ Score and MODS score were 0. 690,0. 915 and 0. 913, respecdvely,on the admission day. Conclusions The PCT can be regarded as a mortality predictor in SIRS patients but less reliable than APACHE Ⅲ Score and MODS score.