降钙素原对自发性脑出血患者临床预后的判断价值

Value of dynamic monitoring the level of procalcitonin in prognostic evaluation in patients with spontaneous intracranial hemorrhage

目的探讨血清降钙素原(PCT)水平与自发性脑出血(sICH)患者感染及临床预后的关系。方法连续纳入2015年9月至2018年12月期间于郑州大学第一附属医院急诊重症监护病房住院的sICH患者130例患者。依据住院期间有无感染划分为感染组和非感染组,根据入院后第28日是否存活,分为存活组与病死组,比较组间入院时及入院后第1、2、3、5日血清PCT水平,并进一步分析PCT水平对并发感染及预后的预测价值。结果感染组患者血清PCT水平在入院时及入院后第1、2、3、5日中位数高于非感染组,差异有统计学意义(均P<0.05)。病死组与存活组患者血清PCT水平入院时比较,差异无统计学意义(P>0.05),但第1、2、3、5日中位数高于存活组,差异有统计学意义(均P<0.01)。第3日PCT水平ROC曲线下面积为0.814(95%CI:0.729-0.900,P<0.01),其最佳截断值为0.216 ng/mL(灵敏度:87%,特异度:67%)。结论PCT高低与患者是否合并感染及感染所致病死密切相关,加强sICH患者PCT监测,对及时启动抗感染治疗、改善预后具有重要意义。

Objective To investigate prognostic significance of serum procalcitonin(PCT)level in patients with spontaneous intracranial hemorrhage(sICH).Methods Totally 130 patients with sICH hospitalized in EICU of the First Affiliated Hospital of Zhengzhou University were chosen consecutively from September 2015 to December 2018.Patients with sICH were divided into two subgroups of the survival and death groups according to the 28-day mortality,and divided into two subgroups of the infection and non-infection groups according to whether there was infection during the admission period.The dynamic value changes of serum PCT levels were monitored at the time of admission,and on the 1st,2nd,3rd and 5th days after admission.Furthermore,the predictive value of PCT level on concurrent infection and prognosis was further analyzed.Results The serum PCT level of the infected group was higher than that of the non-infected group on the 1st,2nd,3rd and 5th days after admission,and the differences were statistically significant(all P<0.05).There was no statistically significant difference in serum PCT level between patients in the disease death group and the survival group at admission(P>0.05),but the median values at the 1st,2nd,3rd and 5th days were higher than those in the survival group,and the differences were statistically significant(all P<0.01).The area under the ROC curve of serum PCT levels on 3rd for predicting the 28-day mortality in sICH patients was 0.814(95%CI:0.729-0.900,P<0.01),and the optimum cutoff value was 0.216 ng/mL(sensitivity:87%,specificity:67%).Conclusion Serum PCT level is positively correlated with disease severity and could predict a poor outcome in sICH patients.Strengthening PCT surveillance has important clinical value for timely initiation of appropriate anti-infection and improvement of prognosis in patients with sICH.