C反应蛋白、血浆白蛋白联合急性生理和慢性健康评分对院内肺部感染重症病人预后价值

Prognostic value of C-reactive protein, plasma albumin and Apache Ⅱ score with nosocomial pulmonary infection

目的研究C反应蛋白(CRP)、血浆白蛋白(ALB)水平联合急性生理和慢性健康评分(APACHEⅡ)用于判断重症医学科(ICU)肺部感染重症病人预后价值。方法选取2017年2月至2019年5月德阳市人民医院ICU发生院内肺部感染重症病人139例,其中114例存活病人为存活组、25例死亡病人为死亡组;病人均于发生肺部感染后24 h行血清CRP、ALB检测及APACHEⅡ评分,比较两组血清CRP、ALB水平及APACHEⅡ评分差异,并分析肺部感染后28 d内死亡的危险因素,并进一步绘制ROC曲线,分析肺部感染后24 h血清CRP、ALB及APACHEⅡ评分单独及联合评估对感染后28 d内死亡的预测价值。结果两组性别、年龄、原发病、合并症等差异无统计学意义(P>0.05),死亡组多器官功能障碍综合征(MODS)所占比例明显高于存活组,差异有统计学意义(68.00%比43.86%,P<0.05)。死亡组肺部感染后24 h血清CRP水平[(93.41±33.32)mg/L比(54.55±17.64)mg/L]、APACHEⅡ评分[(26.84±7.17)分比(21.26±4.91)分]均高于存活组,ALB水平低于存活组[(27.39±4.81)g/L比(30.56±5.49)g/L],差异有统计学意义(P<0.05)。logistic逐步回归分析显示,血清CRP、ALB水平及APACHEⅡ评分均是ICU肺部感染重症病人28 d内病死的独立危险因素(P<0.05)。血清CRP、ALB水平、APACHEⅡ评分单独预测及三者联合预测ICU肺部感染的重症病人感染后28 d内死亡的AUC分别为0.841、0.652、0.736、0.906,三者联合的预测效能更高、敏感度及特异度更加均衡。结论重症病人肺部院内感染后行CRP、ALB水平检测联合APACHEⅡ评分,有助于早期对病人预后进行评估。

Objective To study the prognostic value of C-reactive protein(CRP),plasma albumin(ALB)combined with acute physiology and chronic health score(APACHEⅡ)in patients with severe pulmonary infection in ICU.Methods From February 2017 to may 2019,139 patients with severe pulmonary infection in the ICU of Deyang people’s hospital were selected,including 114 patients in the survival group and 25 patients in the death group.Patients with pulmonary infection after 24 h lines of serum CRP,propagated detection and APACHEⅡscore,compared two groups of patients serum level of CRP,propagated and APACHEⅡscore differences,and analyze the lung infection within 28 d after death risk factors,and further to draw ROC curve analysis of pulmonary infection after24 h of serum CRP,propagated and APACHEⅡscore alone and joint assessment of the predictive value of death within 28 d after infection.Results There was no statistically significant difference between the two groups in gender,age,primary disease and complications(P>0.05).The proportion of MODS in the death group was significantly higher than that in the survival group,and the difference was statistically significant(68.00%vs.43.86%,P<0.05).24 h after death group of patients with lung infection serum CRP level[(93.41±33.32)mg/L vs.(54.55±17.64)mg/L],the APACHEⅡscore[(26.84±7.17)vs.(21.26±4.91)]were higher than in survival group,propagated level is lower than the survival group[(27.39±4.81)g/L vs.(30.56±5.49)g/L],the difference was statistically significant(P<0.05).logistic stepwise regression analysis showed that the serum level of CRP,propagated and APACHEⅡscores are all ICU patients with pulmonary infection in severe illness within 28 d independent risk factors(P<0.05).Serum level of CRP,propagated,APACHEⅡscore predict single and combined forecast ICU patients with pulmonary infection of severe infection after the AUC of death within 28 d were0.841,0.652,0.736,0.906,and the combined prediction efficiency is higher,the sensitivity of the forecast and specific degrees more balanced.Conclusion The detection of CRP and ALB combined with ApacheⅡscore after pulmonary nosocomial infection in severe patients is helpful to evaluate the prognosis of patients in the early stage.