APACHEⅡ评分和降钙素原对肺部感染预后的预测作用

Predictive value of APACHE Ⅱ score and procalcitonin in prognosis of patients with pulmonary infection

目的探讨APACHEⅡ评分和降钙素原对重症监护室肺部感染患者预后的预测价值。方法收集2012年3月到2013年5月本院重症监护室肺部感染患者的临床资料，包括年龄、性别、APACHEⅡ评分、动脉血气、血沉、C-反应蛋白、乳酸、降钙素原、28d结局、ARDS发生情况等，绘制受试者工作特征曲线，比较APACHEⅡ评分和降钙素原对肺部感染患者28d结局及并发ARDS的预测价值。结果纳入患者78例，其中28d内死亡19例，1周内发展为ARDS33例。死亡组APACHEⅡ评分和降钙素原显著高于存活组，分别为[（23．3±7．5）椰（15．5±6．2），P〈0．001]和[18．6（1．5—25．0）ng/mLvs1．0（0．3—25．0）ng/mL，P=0．044]，氧合指数低于存活组，为[（189．7±89．4）YS（238．0±91．7），P=0．048]。ARDS组APACHEⅡ评分和降钙素原显著高于非ARDS组，分别为[（19．9±8．3）VS（15．6±6．0），P=0．013]和[8．3（1．2—25．0）ng／mLvs0．7（0．2—21．8）ng／mL，P=0．016]，氧合指数低于非ARDS组，为[（190．9±82．6）vs（252．1±92．4），P=0．003]。APACHEⅡ评分和降钙素原对28d结局有一定预测作用，APACHEⅡ评分的预测作用大于降钙素原（AUROC：0．797vs0．652，P=0．057）。APACHEⅡ评分和降钙素原对并发ARDS也有一定预测作用，两者预测作用相当（AUROC：O．651vs0．657，P=0．929）。APACHEⅡ评分和降钙素原联合后对28d结局及并发ARDS的预测作用较两者单独的预测作用无显著提高。结论APACHEⅡ评分和降钙素原可以作为肺部感染预后的预测指标，有助于临床早期甄别预后差及具有ARDS高危倾向的患者。

Objective To investigate whether acute physiology and chronic health evaluation II （APACHE ]] ） score and plasma procalcitonin are valuable predictors on the prognosis in patients with pulmonary infection. Methods Patients （n =78） with pulmonary infection in ICU from March 2012 to May 2013 were recruited from Xinqiao Hospital. The data including age, gender, APACHE II score, blood gas analysis, erythrocyte sedimentation, C-reactive protein, lactic acid, procalcitonin, mortality within 28 d, occurrence of acute respiratory distress syndrome（ ARDS）, and so on were collected and analyzed using the receiver operating characteristic curve. Results Among the 78 patients with pulmonary infection, 19 were death cases and 33 were ARDS cases. The statistical analysis showed that as compared to the survival group, APACHE II score and procalcitonin level were significantly higher while the oxygenation index was lower in the death group [23.3 ±7.5 vs 15.5 ±6.2, P〈0.001; 18.6（1.5 -25.0） vs 1.0（0.3 -25.0）ng/mL, P =0. 044; 189.7 ± 89.4 vs 238.0 ±91.7, P =0. 048, respectively]. Similarly, though both of APACHE II score and procalcito- nin level were also significantly higher and the oxygenation index was significantly lower in those who developed ARDS than in those who did not [19.9 ±8.3 vs 15.6 ±6.0, P =0.013; 8.3（1.2 -25.0） vs 0.7（0.2 - 21.8） ng/mL, P = 0. 016; 190.9 ± 82.6 vs 252.1 ± 92.4, P = 0. 003, respectively]. Additionally, the results revealed that APACHE II score or procalcitonin level could solely predicate the occurrence of ARDS （0. 651 vs0.657, P = 0. 929） and mortality within 28 d （0.797 vs O. 652, P = 0. 057）. However, no improvement was found when the two predictors were combined together. Conclusions Both APACHE II score and procalcito- nin level are valuable in predicting the prognosis of patients with pulmonary infection, and help identify patients with high risks of death or ARDS.