血清PCT、NLR联合胸部CT表现预测重症肺炎预后价值分析

Analysis of the prognostic value of serum PCT and NLR combined with chest CT findings in predicting the prognosis of severe pneumonia

目的 分析血清降钙素原(PCT)、中性粒细胞/淋巴细胞比值(NLR)联合胸部CT表现对重症肺炎患者预后的预测价值。方法 选取2018年10月-2020年1月收治的重症肺炎患者95例为重症肺炎组,另选取普通肺炎100例为普通肺炎组。所有患者入院后24h内完成血清PCT、NLR检测,48h内完成胸部CT平扫,对胸部CT影像学表现进行定量分析及视觉评分。对比重症肺炎组与普通肺炎组的血清PCT、NLR及CT评分。重症肺炎组根据患者28d的生存情况分为生存组与死亡组。单因素及多因素Logistic回归分析评价血清PCT、NLR、CT评分对重症肺炎的预后影响;采用受试者工作特征曲线(ROC)评价血清PCT、NLR联合CT评分对重症肺炎预后的预测价值。结果重症肺炎组血清PCT、NLR及CT评分均高于普通肺炎组,差异有统计学意义(P<0.001)。死亡组年龄、血清PCT、C反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞计数(NEU)、NRL、血乳酸(Lac)水平及CT评分高于生存组,差异有统计学意义(P<0.05);多因素Logsitic回归分析显示血清PCT、NRL、Lac、CT评分是影响重症肺炎患者预后的独立危险因素(P<0.05)。ROC显示血清PCT、NRL、CT评分预测重症肺炎预后的约登指数分别为0.331、0.291、0.445,AUC分别为0.684(95%CI:0.590-0.784)、0.695(95%CI:0.592-0.786)、0.759(95%CI:0.660-0.841),血清PCT、NRL联合CT评分预测重症肺炎患者预后的约登指数为0.517,AUC为0.804(95%CI:0.710-0.878),联合预测约登指数及AUC均大于个性指标单独预测。结论 血清PCT、NLR及CT评分可反映重症肺炎患者的病情严重程度,且是影响预后的独立危险因素,三者联合对于预测重症肺炎预后有较高临床价值。

Objective To analyze the predictive value of serum procalcitonin(PCT),neutrophil/lymphocyte ratio(NLR)combined with chest CT findings on the prognosis of patients with severe pneumonia.Methods 95patients with severe pneumonia from October 2018to January 2020were selected as severe pneumonia group,and 100patients with common pneumonia were selected as common pneumonia group.All patients completed serum PCT and NLR detection within 24hours after admission,and chest CT scan within 48hours.Quantitative analysis and visual score of chest CT imaging were performed.The serum PCT,NLR and CT scores of severe pneumonia group and common pneumonia group were compared.The severe pneumonia group was divided into survival group and death group according to the 28-day survival of patients.Univariate and multivariate logistic regression analysis was used to evaluate the influence of serum PCT,NLR and CT scores on the prognosis of severe pneumonia.Receiver operating characteristic curve(ROC)was used to evaluate the predictive value of serum PCT,NLR combined with CT Score in the prognosis of severe pneumonia.Results The serum PCT,NLR and CT scores in severe pneumonia group were higher than those in common pneumonia group(P<0.001).The age,serum PCT,C-reactive protein(CRP),white blood cell count(WBC),neutrophil count(NEU),NRL,blood lactic acid(Lac)levels and CT score of the death group were higher than those of the survival group(P<0.05).Multivariate logistic regression analysis showed that serum PCT,NRL,Lac and CT scores were independent risk factors for the prognosis of patients with severe pneumonia(P<0.05).ROC showed that the serum PCT,NRL,and CT scores predicted the prognosis of severe pneumonia,the Youden index were 0.331,0.291,0.445,and the AUC were 0.684(95% CI:0.590-0.784),0.695(95% CI:0.592-0.786)0.759(95% CI:0.660-0.841),respectively.The Youden index and AUC of serum PCT,NRL combined with CT score in predicting the prognosis of patients with severe pneumonia were 0.517and 0.804(95% CI:0.710-0.878),respectively.The combined prediction of the Youden index and AUC was greater than the individual prediction of personality indicators.Conclusion Serum PCT,NLR and CT scores can reflect the severity of patients with severe pneumonia and are independent risk factors affecting the prognosis.The combination of the three has high clinical value in predicting the prognosis of severe pneumonia.