鲍氏不动杆菌感染患者死亡影响因素及炎症因子对预后评估的价值

Factors affecting death of patients with Acinetobacter baumannii infection and diagnostic value of inflammatory factors on prognosis

目的探讨血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)水平在重症监护病房(ICU)肺部鲍氏不动杆菌感染患者预后的诊断价值,并分析鲍氏不动杆菌感染患者死亡的影响因素。方法选取2015年1月-2019年8月鹰潭市人民医院收治的发生肺部鲍氏不动杆菌感染的ICU患者100例,根据患者28 d后的预后情况分为死亡组(42例)和存活组(58例)。比较两组患者血清PCT、hs-CRP水平和急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官功能衰竭评分(SOFA)评分情况;采用单因素及多因素Logistic回归分析影响ICU肺部鲍氏不动杆菌感染患者预后死亡的影响因素;运用受试者工作特征(ROC)曲线分析PCT、hs-CRP对ICU肺部鲍氏不动杆菌感染患者预后的评估价值。结果 28 d后,ICU肺部鲍氏不动杆菌感染患者的病死率为42.00%。APACHE-Ⅱ评分、SOFA评分、PCT水平、hs-CRP水平是ICU肺部鲍氏不动杆菌感染患者死亡的影响因素(P<0.05)。两项指标联合评估患者预后的特异性、灵敏度、曲线下面积(AUC)分别为88.87%、87.91%、0.885均高于单一指标(P<0.05)。结论血清PCT和hs-CRP水平用于ICU肺部鲍氏不动杆菌感染患者预后具有一定评估价值。

OBJECTIVE To investigate the diagnostic value of serum procalcitonin(PCT) and hypersensitive C-reactive protei(HS-CRP) levels in prognosis of patients with pulmonary Acinetobacter baumaninii infection in intensive care unit(ICU), and to analyze the factors affecting the death of patients with A. baumannii infection. METHODS A total of 100 ICU patients with A. baumannii infection in the lungs who were admitted to Yingtan People′s Hospital from Jan. 2015 to Aug. 2019 were selected, and were divided into death groups(42 cases) and survival group(58 cases) according to the prognosis of the patients 28 days later. The serum PCT and hs-CRP levels, acute physiology and chronic health status scoring system Ⅱ(APACHE Ⅱ), sequential organ failure score(SOFA) scores were compared between the two groups of patients. Univariate and multivariate logistic regression analysis were used to analyze the factors affecting the prognosis and death of ICU patients with A. baumannii infection. Receiver operating characteristics(ROC) curve were used to analyze the prognostic value of PCT and hs-CRP in ICU patients with pulmonary A. baumannii infection. RESULTS After 28 days, the mortality rate of patients with A. baumannii infection in the lungs in the ICU was 42.00%. APACHE-Ⅱ score, SOFA score, PCT level, and hs-CRP level are the influencing factors of death of patients with A. baumannii infection in the lungs of ICU(P<0.05). The specificity, sensitivity, and area under the curve(AUC) of the two indicators combined to assess the prognosis of patients were 88.87%, 87.91%, and 0.885, respectively, significantly higher than a single indicator(P<0.05). CONCLUSION Serum PCT and hs-CRP levels have a certain evaluation value for the prognosis of patients with A. baumannii infection in the ICU.