降钙素原及其清除率对预测急诊监护室老年脓毒症患者预后的价值

The value of procalcitonin and its clearance in predicting the prognosis of elderly patients with sepsis in emergency intensive care unit

目的探讨降钙素原(PCT)及降钙素原清除率(PCTc)对预测急诊监护室老年脓毒症患者预后的价值。方法选取2018年6月-2021年2月在东方医院急诊重症监护室(EICU)确诊为脓毒症的老年患者146例,按28 d生存情况分为存活组(n=77)和死亡组(n=69)。所有纳入患者均在入院24 h内检测PCT浓度,并进行急性生理与慢性健康状况评分(APACHEⅡ评分)和序贯器官衰竭估计评分(SOFA评分);在住院第3、第7日,复测PCT浓度,并计算第3、第7日患者的PCTc。对2组上述检测值进行比较和分析。结果死亡组的年龄、APACHEⅡ评分和SOFA评分均显著高于存活组(P<0.05);第7日死亡组的PCT值显著高于生存组(P<0.05);死亡组2次的PCTc值均显著低于存活组(P<0.05);第7日PCT值及PCTc对老年脓毒症患者预后的判断与常规使用评分系统相当。结论第7日PCT值及PCTc可作为急诊ICU老年脓毒症患者预后判断的参考指标,且PCTc值的判断效价更高。

Objective To evaluate the value of procalcitonin(PCT)and its clearance(PCTc)in predicting the prognosis of elderly patients with sepsis in emergency intensive care unit(EICU).Methods 146 elderly patients with sepsis treated in the EICU of Shanghai East Hospital Affiliated to Tongji University from June 2018 to February 2021 were selected.According to the 28 day survival,they were divided into survival group(n=77)and death group(n=69).All included patients were tested for serum PCT concentration within 24 hours after admission,and the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score and Sequential Organ Failure Assessment(SOFA)score were assessed.On the 3 rd and 7 th days of hospitalization,the PCT concentration was retested and the PCTc values were calculated,respectively.The above indexes of the two groups were compared and analyzed.Results The age,APACHEⅡscore and SOFA score of the death group were significantly higher than those of the survival group(P<0.05).The PCT level on the 7 th day of the death group were significantly higher than that of the survival group(P<0.05).The PCTc values on the 3 rd and 7 th days of the death group were significantly lower than those of the survival group(P<0.05).The effect of judging the prognosis of elderly patients with sepsis based on the PCT level and PCTc on the 7 th day was equivalent to the conventional scoring system.Conclusion PCT level and PCTc on the 7 th day of hospitalization can be used as reference indexes for prognosis judgment of elderly sepsis patients in EICU,and the PCTc has more predictive value.