SICU严重脓毒症患者血清PCT与预后关系探讨

Investigate the relationship between procalcitonin in serum and prognosis in patients with severe sepsis in SICU

目的探讨SICU严重脓毒症患者降钙素原与APCHEII评分以及预后的关系。方法回顾性分析2012年12月至2013年12月中山大学附属第一医院SICU住院的严重脓毒症患者64例,记录患者入SICU的第1、3、7天PCT、超敏C-反应蛋白(CRP)、生命体征、血常规等指标,并计算急性生理与慢性健康状况(APACHEII)评分,建立ROC曲线观察PCT及APACHEII对预后评估的临床价值。结果 64例患者死亡33例(死亡组),存活31例(存活组);死亡组第1、3、7天血清PCT水平(78.49±193.77)ng/m L、(61.55±176.70)ng/m L、(61.68±197.89)ng/m L高于存活组(10.70±15.44)ng/m L、(10.60±21.80)ng/m L、(5.67±8.94)ng/m L,P<0.05;死亡组第1天APACHE II评分(21.15±6.93)高于存活组第1天(18.06±5.40),P<0.05。PCT与APACHEII存在相关性。入ICU第一天PCT水平和APACHEII评分预测死亡的ROC曲线下面积分别为0.625(95%CI 0.49-0.76)和0.623(95%CI 0.49-0.78)。结论严重脓毒症患者入ICU第一天PCT水平判断预后与APACHEII评分相当。

Objective To investigate the relationship between procalcitonin in serum and APCHE II score and prognosis in se -vere septic patients in SICU .Methods Collected 64 cases with severe sepsis hospitalized in SICU of the First Affiliated hospital of Sun Yat-sen University from December 2012 to December 2013 , retrospectively .Monitored the dynamic changes of serum PCT , C-reactive protein （CRP）, vital signs and blood routine test on the 1st,3rd and 7th day after admission to SICU, the Acute Physiology and Chronic Health Evaluation II （ APACHE II） scores were recorded .Compared the serum PCT , APACHE II, white blood cell （WBC）,CRP and other inflammation markers between the two groups .The correlation of PCT and APACHE II was evaluated by spearman correlation analysis .The prediction of mortality of the PCT and APACHE II were evaluated by ROC curves .Results There were 33 patients dead and 31 patients survived.The serum PCT level of the patients in the dead group [（78.49 ±193.77）, （61.55 ± 176.70） and （61.68 ±197.89） ng/ml] were significantly higher than that in the survived group [（10.70 ±15.44）, （10.60 ±21. 80） and （5.67 ±8.94） ng/ml] on the 1st,3th and 7th day（P〈0.05）.The APACHE II score of dead group （21.15 ±6.93） on 1st day was higher than that of survived group （18.06 ±5.40） （P〈0.05）.There is correlation between PCT and APACHEII .The area under the curve （AUC） was 0.625 （95%CI 0.49-0.76） for PCT, and 0.623 （95%CI 0.49-0.78） for APACHE II.Conclusion Severe septic patient’s PCT on 1st day is valuable equal to APACHE II score in prognosis assessment .