血清降钙素原水平对急性卒中患者细菌性肺炎的预测价值：回顾性病例系列研究

Predictive value of serum procalcitonin for acute stroke patients with bacterial pneumonia：a retrospective case series study

目的：探讨急性卒中患者发生细菌性肺炎的危险因素以及早期血清降钙素原（procalcitonin, PCT）水平对细菌性肺炎及脓毒症分级的预测价值。方法回顾性纳入神经重症监护病房急性卒中患者。根据有无细菌性肺炎分为细菌性肺炎组和无感染组,前者再根据脓毒症分级分为非严重脓毒症亚组和严重脓毒症亚组。比较人口统计学、基线临床资料和 PCT 水平（细菌性肺炎组为发生感染时 PCT 水平,无感染组为入院24 h内 PCT 水平）。采用多变量 logistic 回归分析确定细菌性肺炎的独立危险因素。采用受试者工作特征（receiver operator characteristic, ROC）曲线分析 PCT水平对细菌性肺炎和脓毒症分级的预测价值。结果共纳入164例急性卒中患者,细菌性肺炎组114例（非严重脓毒症亚组66例,严重脓毒症亚组48例）,无感染组50例。细菌性肺炎组年龄、空腹血糖水平、格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分和 PCT 水平与无感染组存在统计学差异（P 均＜0．05）。多变量 logistic 回归分析显示,空腹血糖水平≥7 mmol/L[优势比（ odds ratio, OR）8．488,95%可信区间（confidence interval, CI）2．739～26．300；P ＜0．01]、GCS 评分≤8分（OR 11．361,95% CI 2．175～59．352；P ＜0．01）、PCT≥0．050 ng/ml（OR 16．715,95% CI 5．075～55．049；P ＜0．01）为发生细菌性肺炎的独立危险因素。在细菌性肺炎组中,严重脓毒症亚组 PCT 水平[中位数（四分位间距）]显著高于非严重脓毒症亚组[0．835（0．164～1．715）ng/ml 对0．114（0．073～0．275）ng/ml；Z =-4．818,P ＜0．01]。 ROC 曲线分析表明,PCT≥0．070 ng/ml能较好地预测急性卒中患者发生细菌性肺炎,其敏感性为84．2%,特异性为74．0%,ROC 曲线下面积0．865（95% CI 0．806～0．924；P ＜0．01）；PCT≥0．669 ng/ml能较好地预测急性卒中合并细菌性肺炎患者发生严重脓毒症,其敏感性为56．3%,特异性为92．4%,ROC 曲线下面积0．765（95% CI 0．672～0．858；P ＜0．01）。结论急性卒中患者早期血清PCT≥0．050 ng/ml是发生细菌性肺炎的独立危险因素,其水平对细菌性肺炎和感染严重程度均具有一定的预测价值。

Objective To investigate the risk factors for bacterial pneumonia and the predictive value of early serum procalcitonin （PCT） level for bacterial pneumonia and sepsis classification in patients with acute stroke. Methods The patients with acute stroke in neurological intensive care unit were enroled retrospectively and divided into either a bacterial pneumonia group or a non-infection group according to whether they had bacterial pneumonia or not. The former was redivided into a non-severe sepsis subgroup and a severe sepsis subgroup according to the sepsis classification. The demographics, baseline clinical data, and PCT level （the bacterial pneumonia group was the PCT level when infection occurred, the non-infection group was the PCT level within 24 h of admission） were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for bacterial pneumonia. Receiver operator characteristic （ROC） curve was used to analyze the predictive value of serum PCT level for bacterial pneumonia and sepsis 〈br〉 classification. Results A total of 164 patients with acute stroke were enroled in the study, including 114 in the bacterial pneumonia group （66 in the non-severe sepsis subgroup and 48 in the severe sepsis subgroup） and 50 in the non-infection group. There were significant differences in age, fasting blood glucose level, Glasgow coma scale （GCS） score, and PCT level between the bacterial pneumonia group and the non-infection group （P 〈 0. 05 ）. Multivariate logistic regression analysis showed that fasting blood glucose level ≥7 mmol/L （odds ratio [ OR] 8. 488, 95% confidence interval [ CI] 2. 739 - 26. 300; P 〈 0. 01）, GCS score ≤8 （OR 11. 361, 95% CI 2. 175 - 59. 352; P 〈 0. 01）, and PCT level ≥0. 050 ng/ml （OR 16. 715, CI 5. 075 - 55. 049; P 〈 0. 01） were the independent risk factors for bacterial pneumonia. In the bacterial pneumonia group, the PCT level （median; interquartile range） in the severe sepsis subgroup was significantly higher than that in the non-severe sepsis subgroup （0. 835 [ 0. 164 - 1. 715 ] ng/ml vs. 0. 114 [0. 073 - 0. 275 ] ng/ml; Z = 4. 818, P 〈 0. 01 ）. ROC curve analysis showed that PCT ≥0. 070 ng/ml could better predict the occurrence of bacterial pneumonia in patients with acute stroke, with sensitivity of 84. 2% , specificity of 74. 0% and the area under the ROC curve of 0. 865 （CI 0. 806 - 0. 924, P 〈 0. 01）; PCT 0. 669 ng/mlcould better predict the occurrence of severe sepsis in acute stroke patients with bacterial pneumonia, with sensitivity of 56. 3% , specificity of 92. 4% and the area under the ROC curve of 0. 765 （CI 0. 672 - 0. 858; P 〈 0. 01）. Conclusions The early PCT level ≥0. 050 ng/ml was an independent risk factor for occurring bacterial pneumonia in patients with acute stroke, its level had certaln predictive value for bacterial pneumonia and the severity of infection.