降钙素原联合血管外肺水指数在评估脓毒症合并急性呼吸窘迫综合征患者预后中的价值

Value of procalcitonin combined with extravascular lung water index in assessing prognosis of sepsis patients with acute respiratory distress syndrome

目的探讨血清降钙素原(PCT)联合血管外肺水指数(EVLWI)在脓毒症合并急性呼吸窘迫综合征(ARDS)患者预后评估中价值。方法选择55例脓毒症合并ARDS患者,其中住院期间存活28例(存活组)、死亡27例(死亡组)。比较两组患者WBC、C反应蛋白、氧合指数、平均动脉压、中心静脉压、心脏指数、全身血管阻力指数、全心舒张末期容积指数、PCT、EVLWI等指标的差异,采用多因素logistic回归分析探讨影响脓毒症合并ARDS患者预后的相关因素,受试者工作特征曲线(ROC)评价PCT、EVLWI对脓毒症合并ARDS患者死亡的预测效能。结果死亡组PCT、EVLWI高于存活组(P<0.05)。PCT、EVLWI是影响脓毒症合并ARDS患者预后的独立危险因素(P<0.05)。PCT、EVLWI、PCT联合EVLWI判断患者预后的ROC曲线下面积(AUC)分别为0.944、0.908、0.952。结论 PCT和EVLWI均可作为脓毒症合并ARDS患者预后评估有效的指标,二者联合可明显提高对脓毒症合并ARDS患者死亡危险性预测的准确度。

Objective To investigate the value of serum procalcitonin （PCT） combined with extravascular lung water index（EVLWI） in the assessment of the prognosis among sepsis patients with acute respiratory distress syndrome （ARDS）. Methods A total of 55 sepsis patients with ARDS were selected, in which 28 were alive during hospitalization（ survival group） while 27 were dead（ death group）. WBC, C-reactive protein,oxygenation index, mean arterial pressure, central venous pressure, cardiac index, systemic vascular resistance index, global end-diastolic volume index, PCT and EVLWI were compared between the two groups. Multivariate logistic regression analysis was used to investigate the related factors influencing the prognosis of sepsis patients with ARDS, and receiver-operating characteristic （ ROC ） curve to evaluate the prediction efficiency of PCT and EVLWI in the death of sepsis patients with ARDS. Results PCT and EVLWI in the death group were higher than those in the survival group（P 〈0. 05）. PCT,EVLWI were the independent risk factors for prognosis in sepsis patients with ARDS （ P 〈 0.05 ）. The area under the ROC curve （ AUC ） of PCT,EVLWI and PCT combined with EVLWI for prognosis judgment were 0. 944,0. 908,0. 983 respectively. Conclusion Both PCT and EVLWI might act as the effective index to assess the prognosis of sepsis patients with ARDS. Furthermore, PCT combined with EVLWI can obviously improve the accuracy of predicting the mortality risk of sepsis patients with ARDS.