qSOFA评分联合血清D-二聚体、NT-proBNP、PCT检测对高龄医院获得性肺炎患者预后的预测价值

The value of qSOFA score combined with serum D-dimer, NT-proBNP and PCT in predicting the prognosis of elderly patients with hospital-acquired pneumonia

目的探讨q SOFA评分联合血清D-二聚体(D-Dimer DD)、N-末端脑钠肽前体(NT-proBNP)、降钙素原(PCT)检测对高龄医院获得性肺炎(hospital—acquired pneumonia HAP)患者预后预测的临床价值。方法选取2019年1月-2020年12月在海军第905医院接受治疗76例高龄HAP患者作为研究组,根据感染后28 d的情况,分为预后良好组(48例)及预后不良组(28例);另选取同期于海军第905医院体检的高龄健康者39例作为对照组。比较2组的qSOFA评分及血清DD、NT-proBNP和PCT水平;采用Logistic回归分析影响高龄HAP患者预后不良的危险因素;采用Kruskal-Wallis检验对HAP患者qSOFA评分及DD、NT-proBNP、PCT的变化趋势进行分析;采用Spearman相关分析及ROC曲线分析qSOFA评分和DD、NT-proBNP、PCT水平对高龄HAP患者不良预后的诊断效能。结果研究组的qSOFA评分及DD、NT-proBNP、PCT水平均高于对照组(P均<0.01),预后不良组的qSOFA评分及DD、NT-proBNP、PCT水平均高于预后良好组(P均<0.01)。多因素Logistic回归分析显示,PCT是高龄HAP患者预后不良的独立危险因素(OR=96.57,95%CI:1.57~5927.54,P<0.05)。与第1天时比较,预后不良组第3、7和14天时的q SOFA评分增高(P<0.05)。Spearman相关分析显示,q SOFA评分与其他3项指标均呈正相关(P<0.01)。用于预测高龄HAP患者预后不良的ROC曲线下面积依次为PCT(0.97)、DD(0.96)、NT-proBNP(0.88)、qSOFA评分(0.84)。以上4项指标联合检测的ROC曲线下面积为0.99,诊断灵敏度为96%,特异度为100%,均高于单项检测(P<0.01)。结论q SOFA评分及DD、NT-proBNP、PCT水平可作为评估高龄HAP患者预后的参考指标,四项指标联合检测更利于对预后的判断。

Objective To explore the clinical value of q SOFA score combined with serum D-dimer(DD),N-terminal pro-brain natriuretic peptide(NT-proBNP)and procalcitonin(PCT)in predicting the prognosis of senile patients with hospital acquired pneumonia(HAP).Methods 76 senile patients with HAP treated in Hospital 905 of PLA Navy from January 2019 to December 2020 were selected as the study group.According to the outcome of the patients 28 days after infection,they were divided into the good prognosis group(48 cases)and poor prognosis group(28 cases).In addition,39 senile healthy persons who underwent physical examination in the same hospital at the same time were selected as the control group.The qSOFA score and the levels of serum DD,NT-proBNP and PCT were compared between the two groups.Logistic regression was used to analyze the risk factors affecting the prognosis of senile HAP patients,Kruskal-Wallis test was used to analyze the change trend of q SOFA score and the levels of serum DD,NT-proBNP and PCT in patients with HAP,spearman correlation analysis and ROC curve were used to analyze the diagnostic efficacy of qSOFA score and serum DD,NT-proBNP and PCT on the poor prognosis of senile patients with HAP.Results The q SOFA score and the levels of serum DD,NT-proBNP and PCT of the study group were significantly higher than those of the control group(all P<0.01).The q SOFA score and the levels of serum DD,NTproBNP and PCT of the poor prognosis group were significantly higher than those of the good prognosis group(all P<0.01).Logistic regression analysis showed that PCT was an independent risk factor for poor prognosis in senile HAP patients(OR=96.57,95%CI:1.57-5927.54,P<0.05).Compared with the first day,the q SOFA score of the poor prognosis group at the 3 rd,7 th and 14 th day increased(P<0.05).Spearman correlation analysis showed that the qSOFA score was positively correlated with the levels of DD,NT-proBNP and PCT(P<0.05).The area under the ROC curve of PCT,DD,NT-proBNP and q SOFA scores predicting poor prognosis of senile HAP patients were 0.97,0.96,0.88,0.84,respectively.The area under the ROC curve of the combined detection of the above four indexes was 0.99,the diagnostic sensitivity was 96%,and the specificity was 100%,which were all higher than those of single detection(P<0.01).Conclusion q SOFA score and the levels of DD,NTpro BNP and PCT can be used as reference indexes to predict the prognosis of senile patients with HAP.The combined detection of the four indexes is more conducive to the judgment of prognosis.