降钙素原与D-二聚体联合胱抑素C对老年脓毒症并急性肾损伤患者病情及预后评估的价值分析

Value of procalcitonin and D-dimer combined with cystatin C in evaluating the condition and prognosis of elderly patients with sepsis and acute renal injury

目的:探讨降钙素原(PCT)与D-二聚体(D-dimers,D-D)联合胱抑素C(Cys C)对老年脓毒症并急性肾损伤(AKI)患者病情判断和预后的评估价值。方法:回顾性分析住院并诊断为脓毒症的106例老年患者(年龄≥60岁)的临床资料,记录患者PCT、D-D、Cys C、序贯器官衰竭评分(SOFA)评分及28 d预后,根据病情严重程度及28 d预后分组,比较各组的指标差异;绘制受试者工作特征(ROC)曲线,分析上述指标单独或联合应用对老年脓毒症患者预后的评估价值。采用IBM SPSS25统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ^(2)检验。通过Logistic回归分析各项预测因子对预后的影响。结果:脓毒症并急性肾损伤组患者PCT、D-D、Cys C、SOFA评分均明显高于非AKI组;死亡组患者PCT、D-D、Cys C、SOFA评分均明显高于存活组,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,PCT、D-D、Cys C、SOFA评分、PCT+D-D+Cys C的ROC曲线下面积(AUC)分别为0.661、0.638、0.619、0.711、0.728,说明各项指标对老年脓毒症患者28 d预后均有一定预测价值,以三者联合预测价值最大,其特异度为90.3%,灵敏度为47.1%。结论:PCT、D-D、Cys C评分是评估老年脓毒症患者合并急性肾损伤的预测指标,且可评估病情严重程度及预后,三者联合应用具有更高的评估价值。

Objective To investigate the value of procalcitonin and D-dimer combined with cystatin C in judging the condition and prognosis of elderly patients with sepsis and acute renal injury.Method The clinical data of 106 elderly patients(aged ≥ 60 years) hospitalized and diagnosed with sepsis were analyzed retrospectively.The PCT,D-D,Cys C,sofa scores and 28 d prognosis were recorded.The patients were divided into groups according to the severity of the disease and 28 d prognosis,and the index differences among each group were compared.The receiver operating characteristic curve was drawn to analyze the prognostic value of the above indicators alone or in combination in elderly patients with sepsis.The data were analyzed by IBM SPSS25 statistical software.According to the data type,t-test,rank sum test or χ2 inspection.Logistic regression was used to analyze the effect of predictors on prognosis.Results The scores of PCT,D-D,Cys C and sofa in sepsis complicated with acute renal injury group were significantly higher than those in non AKI group(P<0.05).The scores of PCT,D-D,Cys C and sofa in the death group were significantly higher than those in the survival group(P<0.05).ROC curve analysis showed that the area under ROC curve(AUC) of PCT,D-D,Cys C,SOFA score and PCT + D-D + Cys C were 0.661,0.638,0.619,0.711 and 0.728 respectively,indicating that all indicators have a certain predictive value for the 28 d prognosis of elderly patients with sepsis.The combined predictive value of the three is the greatest,with a specificity of 90.3% and a sensitivity of 47.1%.Conclusion PCT,D-D and Cys C scores are predictors of acute renal injury in elderly patients with sepsis,and can evaluate the severity and prognosis.The combined application of the three has higher evaluation value.