降钙素原对外科脓毒症病人预后的判断价值

Prognostic value of procalcitonin in surgical patients with sepsis

目的:结合急性生理与慢性健康评估(APACHEⅡ)探讨降钙素原(procaloitonin,PCT)和其他炎症指标对外科脓毒症病人预后的判断价值。方法:48例外科脓毒症病人根据28 d状况分为生存组(34例)和死亡组(14例)。通过比较两组PCT、白细胞计数(WBC)、中性粒细胞百分比(NE%)、C反应蛋白(c-reactive protein,CRP)和APACHEⅡ的变化,分析PCT等指标与APACHEⅡ的关系。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析外科脓毒症预后。结果:死亡组PCT、CRP和APACHEⅡ显著高于生存组(P<0.05),两组WBC和NE%无差异。Spearman相关分析显示,PCT、CRP与APACHEⅡ呈正相关(P<0.05),WBC和NE%与APACHEⅡ无相关性。ROC曲线分析显示,预测外科脓毒症病人预后的曲线下面积依次为:PCT(0.891)>APACHEⅡ(0.834)>CRP(0.831)。PCT是预测外科脓毒症病人预后的最强因子。当PCT为11.13 ng/m L时,灵敏度和特异度分别为85.7%和85.3%。Logistic回归分析显示,PCT和APACHEⅡ是影响外科脓毒症病人预后的两个独立危险因素(P<0.05)。结论:PCT是评价外科脓毒症病人预后的较好指标。

Objective To investigate the prognostic value of procalcitonin（PCT） and other inflammatory markers in combination with acute physiology and chronic health evaluation（APACHE） Ⅱ in surgical patients with sepsis. Methods A total of 48 surgical patients with sepsis were included in this study and were divided into survival group（ n =34） and mortality group（n=14） according to 28-day death. Blood were collected to measure PCT, white cell count（WBC）, neutrophil percent（NE%） and C-reactive protein（CRP）. APACHE Ⅱ of all surgical patients were recorded. The correlations of PCT and other inflammatory markers with APACHE Ⅱ were analyzed. The prognosis of surgical sepsis was studied with receiver operator characteristic（ROC） curve. Results The levels of PCT, CRP and APACHEⅡ in mortality group were significantly higher than those in survival group（P 0.05）, while there was no significant difference in WBC and NE% between two groups（P0.05）. Spearman correlation analysis showed that both PCT and CRP were positively correlated with APACHE Ⅱ（P0.05） and no relation of APACHEⅡwas present with WBC or NE%. ROC curve analysis showed that the area under the curves of PCT, APACHEⅡ and CRP were 0.891, 0.834, 0.831, respectively, which indicated that PCT was the best factor to predict the risk of mortality in surgical patients with sepsis. When the cutoff value of PCT was at 11.13 ng/m L, the highest of sensitivity and specificity was shown 85.7%, 85.3% respectively. Logistic regression analysis revealed that PCT and APACHE Ⅱ were two independent risk factors to predict the prognosis of surgical patients with sepsis（ P 0.05）.Conclusions PCT might be a good marker in evaluation of prognosis in surgical patients with sepsis.