血Scr与肺炎严重指数在评估重症肺炎患者预后的临床价值

The Clinical Value of Scr and Pneumonia Severity Index in Evaluating the Prognosis of Patients with Severe Pneumonia

目的探讨并分析血肌酐(Scr)与肺炎严重指数在评估重症肺炎患者预后的临床价值。方法回顾性选取2018年7月至2020年7月在本院确诊的102例重症肺炎患者,根据治疗后6个月患者的预后情况分为生存组72例,死亡组30例。记录两组患者年龄、性别、吸烟史、糖尿病史、高血压史、住重症监护室(ICU)时长、机械通气等情况,采用碱性苦味酸(Jaffe)速率法测定两组患者的血Scr,采用酶联免疫吸附试验(ELISA)法测定两组患者的C-反应蛋白(CRP),记录两组患者肺炎严重指数(PSI)、急性生理与慢性健康(APACHEⅡ)评分,采用Logistic回归模型分析影响重症肺炎患者预后的独立危险因素;ROC分析血Scr、PSI、APACHEⅡ、CRP对重症肺炎患者预后的预测价值,分析血Scr、PSI、APACHEⅡ、CRP与重症肺炎患者预后的相关性。结果死亡组患者的血Scr、PSI评分、APACHEⅡ评分、CRP显著高于生存组(P<0.05);重症肺炎患者预后与住ICU时长、年龄、机械通气有关(P<0.05),Logistic回归模型分析显示,血Scr>14μmol/L(OR=3.059,P=0.002)、PSI评分>90分(OR=2.309,P=0.021)、APACHEⅡ评分>45分(OR=3.494,P<0.001)、CRP>10mg/L(OR=2.113,P=0.041)是影响重症肺炎患者预后的独立危险因素;ROC结果显示,血Scr、PSI评分、APACHEⅡ评分、CRP及其联合检测在预测重症肺炎患者预后的AUC分别为0.670、0.689、0.680、0.652、0.802(P<0.05);血Scr、PSI、APACHEⅡ、CRP与重症肺炎患者预后呈现正相关关系(P<0.05)。结论血Scr、PSI评分、APACHEⅡ评分、CRP与重症肺炎患者预后的关系密切,可有效评估重症肺炎患者的预后。

Objective To explore the clinical value of serum creatinine(Scr)and pneumonia severity index(PSI)in evaluating the prognosis of patients with severe pneumonia.Methods A total of 102 patients with severe pneumonia confirmed in the hospital were retrospectively enrolled between July,2018 and July,2020.According to the prognosis at 6 months after treatment,these patients were divided into the survival group(72 cases)and death group(30 cases).Age,gender,smoking history,history of diabetes mellitus,hypertension history,stay duration in intensive care unit(ICU)and mechanical ventilation in both groups were collected.Scr was detected by alkaline picric acid(Jaffe)rate method.C-reactive protein(CRP)was detected by enzyme-linked immunosorbent assay(ELISA).Pneumonia severity index(PSI),acute physiology and chronic health(APACHEⅡ)scores were recorded in both groups.The independent risk factors of prognosis in patients with severe pneumonia were analyzed by using logistic regression model.The predictive values of Scr,PSI,APACHE II and CRP for the prognosis were analyzed by ROC curves,and their correlations with prognosis was evaluated.Results Scr,scores of PSI and APACHE II,and CRP in the death group were significantly higher than those in the survival group(P<0.05).The prognosis of patients with severe pneumonia was related to stay duration in ICU,age and mechanical ventilation(P<0.05).Logistic regression model showed that Scr higher than 14μmol/L(OR=3.059,P=0.002),PSI score higher than 90 points(OR=2.309,P=0.021),APACHE II score higher than 45 points(OR=3.494,P<0.001)and CRP higher than 10 mg/L(OR=2.113,P=0.041)were independent risk factors of prognosis in patients with severe pneumonia.AUCs of Scr,PSI score,APACHE II score,CRP and their combination for predicting prognosis were 0.670,0.689,0.680,0.652 and 0.802,respectively(P<0.05).Scr,PSI,APACHE II and CRP were positively correlated with the prognosis of patients with severe pneumonia(P<0.05).Conclusion Scr,scores of PSI and APACHE II,and CRP are closely related to the prognosis of patients with severe pneumonia,which can be used to effectively assess the prognosis.