血清ALB下降率和CRP/ALB比值在脓毒性休克患者预后评估中的价值研究

Value of decrease rate of serum ALB and CRP/ALB ratio in evaluation of prognosis of patients with septic shock

目的探讨血清白蛋白(ALB)下降率和C-反应蛋白/白蛋白(CRP/ALB)比值对脓毒性休克患者28d预后的早期预测价值。方法回顾性纳入2015年1月-2017年1月宁波市第二医院急诊科收治的脓毒性休克患者62例,分为存活组37例和死亡组25例;检测患者就诊当天和第3天血清ALB和CRP水平,计算CRP/ALB比值和第3天ALB下降率;分析两组患者各时间点指标水平与APACHEⅡ评分的相关性及对预后的预测效力。结果存活组患者第一、三天血清ALB均高于死亡组,CRP、CRP/ALB均低于死亡组(P<0.05);就诊第3天时存活组ALB下降率低于死亡组(t=-5.821,P<0.001);血清ALB与APACHEⅡ评分呈负相关(r=-0.612,P<0.001),ALB下降率、CRP、CRP/ALB比值与APACHEⅡ评分呈正相关(r=0.544,r=0.496,r=0.612,P均<0.001);就诊当日和第3天CRP/ALB预后死亡的AUC分别为0.769和0.886,就诊第3天ALB下降率预测死亡的AUC为0.842。结论脓毒性休克患者血清ALB下降率、CRP/ALB比值与疾病严重程度密切相关,对预后有较好的预测价值。

OBJECTIVE To explore the value of decrease rate of serum albumin（ALB）and C-reactive protein（CRP）/ALB ration in early prediction of 28-day prognosis of patients with septic shock.METHODS A total of 62 patients with septic shock who were treated in emergency department of Ningbo Second Hospital from Jan 2015 to Jan 2017 were retrospectively enrolled in the study and divided into the survival group with 37 cases and the death group with 25 cases.The levels of serum ALB and CRP were detected on the first and third day of treatment,the CRP/ALB ratio and decrease rate of ALB on third day of treatment were calculated.The correlation between the levels of indexes at the time points and APACHE Ⅱscore was analyzed,and the value of the indexes in prediction of prognosis was evaluated.RESULTS The serum ALB level of the survival group was significantly higher than that of the death group on Day 1 and Day 3,while the CRP level and CRP/ALB ratio of the survival group were significantly lower than those of the death group（P〈0.05）.The decrease rate of ALB of the survival group was significantly lower than that of the death group on day 3 of treatment（t=-5.821,P〈0.001）.The serum ALB was negatively correlated with the APACHE Ⅱ score（r=-0.612,P〈0.001）.The decrease rate of ALB,CRP level and CRP/ALB ratio were positively correlated with the APACHE Ⅱ score（r=0.544,r=0.496,r=0.612,all P〈0.001）.The AUC of the CRP/ALB ratio in prediction of death was 0.769 on the first day of treatment,0.886 on the third day of treatment,and the AUC of the decrease rate of ALB in predication of death was 0.842 on the third day of treatment.CONCLUSIONThe severity of illness of the patients with septic shock is closely associated with the decrease rate of serum ALB and CRP/ALB ratio,which have great value in prediction of prognosis.