降钙素原变化率及C-反应蛋白变化率对脓毒性休克评估的价值

Prognostic significance of procalcitonin clearance and C-reactive protein clearance in the patients with septic shock

目的探讨静脉血降钙素原(Procalcitonin,PCT)变化率及C-反应蛋白(Creactive protein,CRP)变化率评估脓毒性休克预后的临床价值。方法回顾性研究安徽医科大学第一附属医院急诊重症监护病房(ICU)及重症医学科2016年7月至2020年12月诊治的脓毒性休克患者,共150例。分别检测患者入室时(PCT0、CRP0)、入室72 h(PCT1、CRP1)静脉血PCT、CRP水平,并计算PCT、CRP变化率(分别ΔPCT、ΔCRP)。根据患者最终28 d生存情况分为死亡组和非死亡组,依据年龄分为老年组(年龄≥60岁)和非老年组(年龄<60岁),依据感染灶分为肺源性组和其他源性组,分别比较两组患者ΔPCT、ΔCRP对预后的评估价值。结果 (1)死亡组59例,非死亡组91例,两组患者ΔPCT分别为0.961(0.383,4.830)、0.703(0.414,0.838),ΔCRP分别为0.648(0.276,2.600)、0.483(0.207,0.750),两组比较差异均有统计学意义(P<0.05)。(2)老年组96例,其中生存58例,死亡38例,死亡组与非死亡组ΔPCT分别为0.987 (0.541,4.178)、0.703(0.432,0.838),ΔCRP分别为0.731 (0.256,2.600)、0.475 (0.177,0.761),两组比较差异均有统计学意义(P<0.05);非老年组54例,其中生存33例,死亡21例,死亡组与非死亡组ΔPCT分别为0.834(0.192,5.202)、0.762(0.408,0.817),ΔCRP分别为0.519(0.368,2.227)、0.499(0.230,0.697),两组比较差异均无统计学意义(P>0.05)。(3)肺部感染致脓毒性休克患者92例,其中生存51例,死亡41例,死亡组与非死亡组ΔPCT分别为1.010(0.553,5.202)、0.607(0.414,0.832),ΔCRP分别为0.758(0.276,2.638)、0.468(0.243,0.754),两组比较差异有统计学意义(P<0.05)。其他源性脓毒性休克患者58例,其中生存40例,死亡18例,死亡组与非死亡组ΔPCT分别为0.684(0.176,2.355)、0.746(0.408,0.848),ΔCRP分别为0.508(0.202,1.064)、0.492(0.203,0.733),两组比较差异无统计学意义(P>0.05)。(4)ΔPCT受试者工作特征(ROC)曲线下面积(AUC)为0.659,敏感度为50.8%,特异度为94.5%,而ΔCRP AUC为0.624,敏感度为40.7%,特异度为91.2%。结论 (1)静脉血ΔPCT、ΔCRP能较好地评估脓毒性休克患者28 d住院病死率,并且ΔPCT预测价值优于ΔCRP;(2)较之中青年患者,ΔPCT、ΔCRP对老年脓毒性休克患者早期预后评估价值更大;(3)从病因角度,与其他源性感染相比,ΔPCT、ΔCRP对肺部感染引起脓毒性休克的临床评估意义更佳;(4)两者联合检测的准确性高于单一检测任一指标。

Objective To study the clinical value of the change rate of procalcitonin(PCT) and C-reactive protein( CRP) in venous blood in evaluating the prognosis of septic shock. Methods A retrospective study was performed on 150 patients with septic shock treated in the Emergency ICU and Critical Care Medicine Department of the First Affiliated Hospital of Anhui Medical University from July2016 to December 2020. PCT and CRP of venous blood were detected when the patients were on admission( PCT0,CRP0) and 72 hours after admission( PCT1,CRP1),and the clearance of the PCT and CRP( ΔPCT,ΔCRP) were also calculated. Patients were divided into the death group and the non-death group according to their final 28-day survival,they were divided into elderly group and non-elderly group according to the age, and according to the infection focus, they were divided into pulmonary group and other group. The evaluation value of ΔPCT and ΔCRP in the prognosis was compared between the two groups. Results(1) There were 59 cases in death group and 91 cases in non-death group. ΔPCT of two groups was 0. 961( 0. 383,4. 830),0. 703( 0. 414,0. 838),ΔCRP was 0. 648( 0. 276,2. 600),0. 483( 0. 207,0. 750),and the difference between the two groups was statistically significant( P<0. 05).(2) 96 cases of patients with more than 60 years old included 58 cases of survival,38 cases of death. ΔPCT in the death group and the non-death group was 0. 987( 0. 541,4. 178),0. 703( 0. 432,0. 838),ΔCRP was 0. 731( 0. 256,2. 600),0. 475( 0. 177,0. 761),the difference was statistically significant( P<0. 05);54 patients with less than 60 years old included 33 cases of survival,21 cases of death,ΔPCT in the death and the non-death group was 0. 834( 0. 192,5. 202),0. 762( 0. 408,0. 817),ΔCRP was 0. 519( 0. 368,2. 227),0. 499( 0. 230,0. 697),and there was no statistically significant difference( P>0. 05).(3) 92 cases of septic shock patients had pulmonary infection,51 cases survived,and 41 cases died. ΔPCT in the death group and the non-death group was1. 010( 0. 553,5. 202),0. 607( 0. 414,0. 832),ΔCRP was 0. 758( 0. 276,2. 638),0. 468( 0. 243,0. 754),the difference was statistically significant( P<0. 05). In 58 patients of septic shock induced by other causes,40 cases survived,18 cases died,ΔPCT in the death group and the non-death group was0. 684( 0. 176,2. 355),0. 746( 0. 408,0. 848),ΔCRP was 0. 508( 0. 202,1. 064),0. 492( 0. 203,0. 733),there was no statistically significant difference( P>0. 05).(4) The area under the ROC curve( AUC) of ΔPCT was 0. 659,sensitivity was 50. 8%,and specificity was 94. 5%. The AUC of ΔCRP was0. 624,sensitivity was 40. 7%,and specificity was 91. 2%. Conclusions ΔPCT,ΔCRP both can predict28-day in-hospital mortality of septic shock patients,also are valuable to predict early death risk for elderly patients and septic shock patients with pulmonary infection. ΔPCT has a better predictive value than ΔCRP. The accuracy of combined detection is higher than that of single detection.