临床肺部感染评分和降钙素原对于评估EICU老年重症社区获得性肺炎患者病情及预后的意义

The significance of clinical pulmonary infection score and procalcitonin to assess the EICU elderly patients with severe community-acquired pneumonia

目的：探讨临床肺部感染评分（CPIS）和降钙素原（PCT）对评估老年重症社区获得性肺炎（SCAP）患者病情和预后的意义。方法：收集2012-01-2014-12我院急诊重症监护病房（EICU）收治的85例老年SCAP患者的临床资料,记录患者1周内急性呼吸窘迫综合征（ARDS）的发生情况,将患者分为ARDS组和非ARDS组,并随访患者28d预后情况,将患者分为生存组和死亡组,分别比较ARDS组与非ARDS组、死亡组和生存组CPIS和PCT的差异,并分析影响患者28d预后的独立危险因素。结果：85例患者中,入院1周内并发ARDS 36例,28d内死亡27例。ARDS组CPIS评分高于非ARDS组[（8.0±2.0）vs.（5.5±2.9）,P〈0.05],2组PCT比较差异无统计学意义（P〉0.05）;死亡组CPIS评分和PCT均高于生存组[（8.7±1.1）vs.（5.6±2.8）,P〈0.05;4.8（3.0~10.1）ng/ml vs.0.9（0.4~2.1）ng/ml,P〈0.05]。CPIS评分和APACHEⅡ评分预测患者28d预后的ROC曲线下面积（AUC）比较,差异无统计学意义,CPIS评分和PCT均为影响老年SCAP患者28d预后的独立危险因素。结论：CPIS和PCT对于评估EICU老年SCAP患者病情,识别高危患者和判断预后具有重要意义,二者均是影响老年SCAP患者28d预后的独立危险因素。

Objective：To investigate the significance of the clinical pulmonary infection score（CPIS）and procalcitonin（PCT）in EICU elderly patients with severe community-acquired pneumonia（SCAP）.Method：Collect the clinical data of the elderly SCAP patients from January 2012 to December 2014 in emergency intensive care unit（EICU）of our hospital.The occurrence of acute respiratory distress syndrome（ARDS）within 1week was recorded and the patients were divided into ARDS group and non ARDS group according to the results.The patients＇ clinical outcome of 28 dwas followed up and then the patients were divided into survival group and death group.Compare the difference of CPIS and PCT between ARDS group and non ARDS group and between death group and survival group.Analyze the independent risk factors that can influence 28 dprognosis.Result：A total of 85 cases were included in the study.There were 36 cases coupled with ARDS within 1week,and 27 cases died within 28 days.The CPIS score in the ARDS group was significantly higher than that of non ARDS Group[（8.0±2.0）vs.（5.5±2.9）,P〈0.05],and there was no statistical difference of PCT between the two groups（P〉0.05）.The CPIS score and PCT of death group were significantly higher than that of the survival group respectively[（8.7±1.1）vs.（5.6±2.8）,P〈0.05;4.8（3.0~10.1）ng/ml vs.0.9（0.4~2.1）ng/ml,P〈0.05].Comparing the area under the ROC curve of CPIS and APACHEⅡ,there was no statistical difference of predicting 28 doutcome between them.Both the CPIS score and PCT were the independent risk factor for the 28 day prognosis.Conclusion：The CPIS and PCT have great significance for the assessment of the EICU elderly patients with SCAP,identification of patients at risk,and judgment of prognosis.Both of them are independent risk factors for the 28 day prognosis.