动态监测乳酸、PCT、CRP对ICU脓毒症-3患者预后的价值

The Value of Dynamic Monitoring of Lactate,PCT and CRP on the Prognosis of Patients with Sepsis-3 in ICU

目的探讨动脉血乳酸、PCT、C-反应蛋白水平对ICU脓毒血症-3患者预后的预测价值。方法选取我院2020年1月~12月ICU收治的脓毒症-3患者84例,按照预后分为死亡组37例,存活组47例,分别比较两组入院时、12、24、36、48 h、转出(或死亡)当天乳酸水平及入住ICU第1、3、7天及转出(或死亡)当天PCT、CRP水平,采用受试者工作特征曲线(ROC)分析其对脓毒症-3患者预后的预测价值。结果死亡组观察期间乳酸水平、入院第7天及死亡当天PCT、CRP水平高于存活组,差异有统计学意义(P<0.05)。ROC曲线分析显示:血乳酸AUC为0.83,最佳阈值为1.55 mmol/L,约登指数为0.52时,敏感度为83.30%,特异度为68.40%;入院第7天AUCPCT为0.79,最佳阈值为0.57 ng/ml,约登指数为0.52时,敏感度为75.00%,特异度为76.90%;转出或死亡当天AUCCRP为0.83,最佳阈值为56.68 mg/L,约登指数为0.76时,敏感度为87.50%,特异度为88.90%。结论动态监测动脉血乳酸、PCT、CRP水平对于改善脓毒症-3患者预后,提高患者生存质量,提高生存率具有重要意义。

Objective To explore the predictive value of arterial blood lactate,PCT,and C-reactive protein levels in the prognosis of ICU patients with sepsis-3.Methods A total of 84 patients with sepsis-3 who were admitted to the ICU in our hospital from January to December 2020 were selected.According to the prognosis,they were divided into 37 cases in the death group and 47 cases in the survival group.The lactic acid levels at admission,12,24,36,48 h,the day of transfer(or death),and the levels of PCT and CRP on the first,3,and 7 d of ICU admission and the day of transfer(or death)were compared between the two groups respectively.The receiver operating characteristic curve(ROC)was used to analyze its predictive value for the prognosis of patients with sepsis-3.Results The levels of lactate in the observation period,PCT and CRP levels on the 7th d of admission and the day of death in the death group were higher than those in the survival group,the differences were statistically significant(P<0.05).ROC curve analysis showed that:blood lactate AUC was 0.83,the best threshold was 1.55 mmol/L,and the Youden index was 0.52,the sensitivity was 83.30%,and the specificity was 68.40%;On the 7th d of admission,the AUCPCT was 0.79,the optimal threshold was 0.57 ng/ml,and the Youden index was 0.52,the sensitivity was 75.00%,and the specificity was 76.90%;The AUCCRP on the day of transfer or death was 0.83,the optimal threshold was 56.68 mg/L,and the Youden index was 0.76,the sensitivity was 87.50%,and the specificity was 88.90%.Conclusion Dynamic monitoring of arterial blood lactate,PCT,and CRP levels is of great significance for improving the prognosis of patients with sepsis-3,improving the quality of life of patients,and improving the survival rate.