C反应蛋白对重症社区获得性肺炎患者住院期间死亡的预测价值

Predictive value of serum C - reactive protein for hospital death in patients with severe community-acquired pneumonia

目的评价重症社区获得性肺炎(community-acquired pneumonia,CAP)患者就诊时血清C反应蛋白(C-reactive protein,CRP)对其发生住院期间死亡事件的预测价值。方法回顾性分析2006年9月至2010年9月期间202例因重症CAP住院治疗患者的临床资料,提取出患者就诊时的血清CRP浓度以及肌酐、红细胞沉降率、白细胞计数等数据。根据治疗效果将患者分为住院期间死亡组(死于CAP并发症)和存活组,分别以受试者工作特征曲线(ROC)法和多元logistic回归分析研究CRP与患者发生住院期间死亡事件的关系。结果死亡组和存活组患者血清CRP中位水平(四分位间距)分别为327.00(246.25,411.50)mg/L和167.00(132.50,208.50)mg/L,差异具有统计学意义(Z=-7.481,P<0.001)。ROC分析表明:血清CRP对预测患者发生住院期间死亡事件具有较高的预测效力,其曲线下面积(AUC)达到了0.85[95%可信区间(0.78,0.91)];以230.50 mg/L为界点时,其预测患者发生住院期间死亡事件的敏感性为0.83[95%可信区间(0.76,0.89)],特异性为0.79[95%可信区间(0.65,0.89)]。Logistic回归结果表明:在校正了年龄、肌酐、红细胞沉降率后,CRP仍然与重症CAP患者住院期间发生死亡事件相关(OR=13.42,P<0.01)。结论血清CRP水平对重症CAP患者发生住院期间死亡事件具有较高的预测价值。

Objective To evaluate the predictive value of serum C-reactive protein（CRP） for hospital death events in patients with severe community-acquired pneumonia（CAP）.Methods The clinical data of 202 patients with CAP in Changhai Hospital and Second People＇s Hospital of Wuxi between Sep.2006 and Sep.2010 were retrospectively reviewed.The clinical and laboratory parameters,including the serum CRP level,white blood cell count,erythrocyte sedimentation rate（ESR） and serum creatine concentration were collected from Hospital Information System（HIS） and Laboratory Information System（LIS）.The patients were divided into two groups according to the final death（CAP related complications） or survival of patients in the hospital.The receiver operating curve（ROC） analysis and multivariable logistical model were used to assess the predictive value of CRP on hospital death events.Results The median（interquartile range） serum CRP level of survival patients and patients who died during the hospital stay were 167.00（132.50,208.50） mg/L and 327.00（246.25,411.50） mg/L,respectively（Z=-7.481,P0.001）.ROC analysis showed that CRP was an effective predictor for hospital death of CAP patients,with the area under curve（AUC） being 0.85（95%CI： 0.78-0.91）.The optimal cot-off value for serum CRP was 230.50 mg/L,with the sensitivity being 0.83（95%CI： 0.76-0.89） and specificity being 0.79（95%CI： 0.65-0.89）.Logistic regression analysis showed that,after adjusted for age,serum creatinine and ESR,CRP on admission was still independently associated with hospital death of CAP patients（OR=13.42,P0.01）.Conclusion Increased CRP is an independent risk factor for hospital death events in patients with severe CAP.