老年患者社区获得性血流感染的急诊预测指标

Study of predictive markers in emergency elderly patients with community-acquired bloodstream infection

目的探讨血清降钙素原(procalcitonin,PCT)、CRP及WBC对社区获得性血流感染(community-acquired bloodstream infection,CABSI)老年患者的预测价值,为急诊医师早期识别CABSI提供参考依据。方法回顾性分析2017年1~12月北京积水潭医院收治的292例老年CABSI患者的临床资料。结果292例患者中血培养阳性87例,PCT阳性率94.17%,血培养阴性205例,PCT阳性率25.81%(P<0.05)。采用ROC分析,PCT>3.01 ng/ml时预测CABSI的敏感度、特异性、阳性预测值和阴性预测值分别为86.2%、91.5%、80.4%和65.5%;CRP>96.5 mg/L时,预测CABSI的敏感度、特异性、阳性和阴性预测值分别为64.4%、75.9%、53.3%和83.4%;WBC>10.1×109/L时预测CABSI的敏感度、特异性分别为71.3%、62.8%。结论PCT对老年CABSI患者有较好的预测价值,能为急诊医师早期识别CABSI提供一定参考。

Objective To study the predictive values of serum procalcitonin(PCT),CRP and WBC in the elderly patients with community-acquired bloodstream infections,so as to provide references for emergency treatment.Methods Retrospective study on clinical data of 292 elderly patients with clinical diagnosis of community-acquired bloodstream infection in Department of Emergency Beijing Jishuitan Hospital from January to December 2017.Results The positive rate of PCT was 94.17%in 87 elderly patients with positive blood culture and 25.81%in 205 cases of negative blood culture.ROC curve analysis showed,the sensitivity,specificity,positive predictors and negative predictors of community-acquired bloodstream infections in elderly patients with PCT level greater than 3.01 ng/ml were 86.2%,91.5%,80.4%and 65.5%,respectively.When CRP level was greater than 96.5 mg/L,the sensitivity,specificity,positive predictors and negative predictors of community-acquired bloodstream infections in emergency elderly patients were 64.4%,75.9%,53.3%and 83.4%,respectively.When WBC level was greater than 10.1×10~9/L,the sensitivity,specificity of community-acquired bloodstream infections in emergency elderly patients were 71.3%and 62.8%.Conclusions Serum PCT can provide some reference for early identification of community-acquired bloodstream infection in elderly patients by emergency physicians.