血清降钙素原和CURB-65评分以及APACHEⅡ评分对急诊老年社区获得性肺炎患者预后中的预测价值研究

Predictive value of serum procalcitonin,CURB-65 score and APACHEⅡscore in the prognosis of elderly patients with community-acquired pneumonia in emergency department

目的探讨PCT水平联合CURB-65评分系统以及APACHEⅡ评分系统快速评估急诊科老年重症CAP患者的严重程度。方法选取2017年11月—2020年1月复旦大学附属华东医院急诊病房收住的101例CAP老年患者,依患者是否院内死亡分为存活组74例,死亡组27例。入院当天根据体检和实验室结果,计算患者的CURB-65评分、APACHEⅡ评分。比较2组CURB-65评分、APACHEⅡ评分及PCT之间的关系。绘制患者受试者工作特征曲线(receiver operating characteristic curve,简称ROC曲线),计算曲线下面积(area under the cure,AUC)、敏感度、特异度等指标。P<0.05为差异有统计学意义。结果2组患者在PCT、CURB-65评分上差异无统计学意义,但死亡组患者的APACHEⅡ评分高于存活组,且P无限接近于0。使用PCT、CURB-65评分、APACHEⅡ评分绘制患者的ROC曲线,其AUC分别为0.609(95%CI 0.481~0.738)、0.727(95%CI 0.608~0.846)、0.997(95%CI 0.985~1.000)。APACHEⅡ评分的最佳临界值为17。将CURB-65评分与PCT的曲线做线性合并后,得到CURB-65联合PCT曲线。CURB-65评分+PCT联合的AUC为0.791(95%CI 0.68~0.90)。PCT、CURB-65评分及两者联合曲线均未能找出较为理想的临界值。结论本研究认为对于老年CAP患者,APACHEⅡ评分能较好的反映疾病严重程度,参考临界值为17,PCT及CURB-65评分系统均不能令人满意。

Objective To explore the value of serum procalcitonin(PCT)combined with CURB-65 scoring system and APACHEⅡscoring system in rapidly evaluating the prognosis of elderly patients with severe community-acquired pneumonia(CAP)in emergency department.Methods 101 elderly patients with CAP admitted to the Emergency Ward of Huadong Hospital from November 2017 to January 2020 were selected.According to whether the patients died in hospital or not,they were divided into the survival group(n=14)and death group(n=21).On the day of admission,the CURB-65 score and APACHEⅡscore of the patients were calculated according to the physical examination and laboratory results.The relationship between CURB-65 score,APACHEⅡscore and PCT level was compared between the two groups.The receiver operating characteristic curve(ROC curve)was drawn,and the area under the curve(AUC),sensitivity,specificity and other indicators were calculated.Results There was no significant difference in PCT level and CURB-65 scores between the two groups,but the APACHEⅡscore of the death group was higher than that of the survival group,and the P value was infinitely close to 0.The ROC curves of patients were drawn according to PCT level,CURB-65 score and APACHEⅡscore,and the AUCs were 0.609(95%CI 0.481-0.738),0.727(95%CI 0.608-0.846)and 0.997(95%CI 0.985-1.000),respectively.The optimal cutoff value for the APACHEⅡscore was 17.After linearly combining the CURB-65 score curve and the PCT curve,the CURB-65 combined PCT curve was obtained,and the AUC of the combination of CURB-65 score and PCT was 0.791(95%CI 0.68-0.90).PCT,CURB-65 scores and their combined curves failed to find an ideal cutoff value.Conclusion For elderly CAP patients,the APACHEⅡscore can better reflect the severity of the disease,with a reference cutoff value of 17.PCT and CURB-65 scoring systems are unsatisfactory.