降钙素原在社区获得性肺炎预后评估中的价值

The prognostic value of procalcitonin for community-acquired pneumonia

目的评价入院降钙素原(procalcitonin,PCT)水平在社区获得性肺炎(community-acquired pneumonia,CAP)严重性分层及预后评估中的价值;评价PCT结合经过验证的临床风险评分(PSI评分和CURB-65评分)对CAP患者死亡风险的预测能力。方法回顾性分析2015年3月至2016年3月天津医科大学总医院呼吸科收治的符合CAP入选标准的150例住院患者的临床资料及预后。根据临床资料计算患者的CURB-65评分及PSI评分。主要研究终点为30天死亡风险。评价PCT及其与风险评分结合对死亡风险的预测能力。结果纳入150例CAP住院患者,其中男77例,女73例,平均年龄(58.4±16.3)岁。12(8%)例患者30天内死亡。死亡患者PCT水平中位数(4.25 ng/ml vs 0.24 ng/ml)及C-反应蛋白(CRP)水平中位数(14.60 mg/dl vs 5.10 mg/dl)均显著增高。两种风险评分更高的患者PCT水平显著增高。PCT与风险评分结合可改善对CAP患者30天死亡风险预测能力。结论入院PCT水平在CAP严重性分层及预后评估中有一定价值,可以较好的鉴别死亡风险较低的患者。与两种风险评分(CURB-65,PSI)相比,PCT预测CAP患者30天死亡风险并无优势,推荐PCT结合风险评分评价CAP患者30天死亡风险。

Objective To investigate the value of procalcitonin （PCT） at admission for severity stratificaton and prognosis prediction of community-acquired pneumonia （CAP）, and assess the ability of the combination of PCT and the validated pneumonia risk scores （PSI and CURB-65） for predicting 30-day mortality. Methods A retrospective study was performed in 150 hospitalized CAP patients admitted in the Department of Respiratory Medicine of General Hospital of Tianjin Medical University between March 2015 and March 2016. The primary end point for this study was mortality within 30 days. Sensitivity （SEN）, specificity （SPE）, positive and negative predictive value （PPV, NPV） of PCT for assessing mortality was calculated and compared to validated pneumonia risk scores. Results In the 150 CAP patients enrolled, there were 77 males and 73 females with an average age of 58.4_＋16.3 years. Twelve （8%） patients died within 30 days. The non-survivors had significantly higher median PCT level （4.25 ng/ml vs. 0.24 ng/ml） and C-reactive protein （CRP） level （14.60 mg/dl vs. 5.10 mg/dl） compared with the survivors. The median PCT level was significantly higher in the patients with more severe disease assessed by two risk scoring systems. Combination of PCT with risk scores can improve prognostic value for predicting 30-day mortality of CAP. Conclusions The level of PCT at admission is more useful than the traditional biomarkers for the severity stratification and prognosis prediction of CAP. It can well determine patients at low risk of mortality from CAP. There is no advantage of PCT compared to PSI or CURB-65, so we recommend combination of PCT to risk sores to predict 30-day mortality of CAP.