血清降钙素原水平联合CURB评分对老年重症社区获得性肺炎死亡的预测价值

Predictive value of serum procalcitonin level and CURB scoring system for mortality risk in elderly patients with severe community-acquired pneumonia

目的探讨血清降钙素原(PCT)水平联合CURB评分预测老年重症社区获得性肺炎(SCAP)死亡风险的临床价值。方法选择105例老年SCAP患者为研究对象,根据入院后28 d生存情况分为死亡组29例和生存组76例。入院24 h内进行肺炎严重度指数(PSI)、CURB评分。入院后第1天和第4天应用化学发光法进行血清PCT水平检测。采用多因素Logistic回归分析老年SCAP死亡风险的独立危险因素,采用ROC曲线下面积评估各项独立危险因素的预测效能。结果 (1)死亡组PSI≥130分和CURB≥3分患者所占比例均高于生存组(P均<0.05)。死亡组入院第4天PCT、第4天与第1天血清PCT水平的差值高于生存组(P均<0.05);(2)多因素Logistic回归分析显示,入院第4天PCT水平、第4天与第1天PCT水平的差值及CURB评分≥3分与SCAP死亡相关(P<0.05),是影响老年SCAP预后的独立危险因素;(3)ROC曲线下面积(AUC)分析显示,第4天PCT、第4天与第1天血清PCT水平的差值及CURB≥3分联合的预测效能较单一指标高,AUC为0.85,灵敏度为81.6%,特异度为90.5%,约登指数为0.721。结论入院后PCT动态变化情况结合CURB评分对于预测老年SCAP死亡风险有一定临床价值。

Objective To explore the predictive value of serum procalcitonin（ PCT） level and CURB scoring system for mortality risk in elderly patients with severe community-acquired pneumonia（ SCAP）. Methods 105 cases of elderly patients with SCAP were included in this study. All patients were divided into death group（ n = 29） and survival group（ n =76） according to the situation of survival 28 d after admission. Pneumonia severity index（ PSI） and CURB scores were evaluated within 24 h after admission. Serum procalcitonin levels were detected by using the chemiluminescence method 1 d and 4 d after admission. The independent risk factors of death were analyzed by using multivariable Logistic regression analysis. The predictive efficiency of independent risk factors were assessed by the area under the ROC curve. Results（ 1） Both proportions of patients with PSI≥130 and CURB≥3 in death group were higher than those in survival group（ P0. 05）. The serum PCT level 4 d after admission and the differentials of serum PCT levels between 4 d and 1 d after admission in death group were higher than those in survival group（ P〈0. 05）.（ 2） The serum PCT level 4 d after admission,the differentials of serum PCT levels between 4 d and 1 d after admission,CURB ≥3 were related to SCAP death（ P0. 05）.（ 3） The area under the ROC curve showed that,compared with single index,the predictive efficiency of the combination of serum PCT levels 4 d after admission,the differentials of serum PCT levels between 4 d and 1d after admission,CURB≥3 scores was higher. The AUC was 0. 85,and the sensitivity,the specificity and Youden index was81. 6%,90. 5%,and 0. 721 respectively. Conclusions The dynamic change of PCT combined with CURB has certain clinical value of predicting the mortality risk in elderly patients with SCAP.