降钙素原联合激活素A评估老年重症脓毒症患者预后的价值

Serum procalcitonin and activin-A levels in prognosis assessment of elderly patients with severe sepsis

目的观察老年重症脓毒症患者降钙素原(PCT)和激活素A水平动态变化及其在预后和病情评估中的价值。方法对66例老年重症脓毒症患者随访28d,根据预后分为存活组48例和死亡组18例,比较两组患者入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)和序贯器官衰竭(SOFA)评分,检测入院时、入院第3、5、7天CRP、乳酸、PCT和激活素A水平,分析两者与SOFA评分、APACHEⅡ评分的相关性及其预测预后的价值。结果两组入院时及入院第3天血清PCT水平和入院时激活素A水平分别比较差异均无统计学意义(均P>0.05);死亡组入院时C反应蛋白(CRP)、乳酸、SOFA评分和APACHEⅡ评分均明显高于存活组(均P<0.05);死亡组入院第5、7天PCT水平和入院第3、5、7天激活素A水平均明显高于存活组(均P<0.05),与同组入院时比较差异无统计学意义(P>0.05);存活组入院后第5、7天PCT和激活素A水平较同组入院时明显下降(P<0.05);入院第5、7天PCT水平和入院第3、5、7天激活素A水平分别与SOFA评分、APACHEⅡ评分均呈正相关;PCT和激活素A预测死亡的ROC曲线下面积(AUC)分别为0.815和0.826。结论血清PCT和激活素A水平可评估老年重症脓毒症患者预后,两者持续保持高水平提示预后不良。

Objective To evaluate serum procalcitonin and activin-A levels in prognosis assessment of elderly patients with severe sepsis. Methods Sixty six elderly patients with severe sepsis were scored with APACHE and SOFA at admission.Serum levels of procalcitonin, activin-A, CRP, lactic acid were measured at d1, d3, d5 and d7 of admission. The correlation of serum procalcitonin and activin-A levels with APACHE Ⅱ and SOFA was analyzed. Results All patients were followed up for 28 days, 48 patients survived（surviving group） and 18 died（fatal group） during the follow up. There were no significant differences in serum procalcitonin levels at d1, d3 and activin-A levels at d1 of admission between two groups（P〉0.05）. The lactic acid level,SOFA score and APACHE Ⅱ score in fatal group were significantly higher at d1 of admission than those in survival group（P〈0.05）. The procalcitonin levels at d5 and d7 of admission, activin-A levels at d3, d5, d7 in fatal group were significantly higher than those in survival group（P〈0.05）, while there was no significant difference at d1 of admission between two groups. The procalcitonin and activin-A levels were significantly lower in survival group at d5 and d7 than those at d1（P〈0.05）. The procalcitonin levels at d5,d7 and activin-A levels at d3, d5, d7 were positively correlated with SOFA score and APACHE Ⅱ score（P〈0.05）. The area under curve（AUC） of procalcitonin and activin-A for predicting death were 0.815 and 0.826. Conclusion Procalcitonin and activin-A can be used to assess the prognosis of elderly patients with severe sepsis, and high level procalcitonin and activin-A indicates a poor prognosis.