血清CRP、PCT水平动态监测在G-血流感染脓毒症患者病情评估中的应用价值

Application Value of Dynamic Monitoring of Serum CRP and PCT Levels in the Evaluation of G-bloodstream Infection Sepsis Patients

目的动态监测革兰阴性菌(G-)血流感染脓毒症患者血清C反应蛋白(CRP)、降钙素原(PCT)水平,并分析其在患者病情评估中的应用价值。方法选取2019年1月至2020年12月漯河市第三人民医院收治的102例G-血流感染脓毒症患者,根据病情程度分为脓毒症组(N=68)、脓毒症休克组(N=34),均于入院后24 h、入院后48 h、入院后7 d、入院后14 d检测血清CRP、PCT水平,同时进行序贯器官衰竭(SOFA)评分、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分评估,并根据其28 d预后情况分为预后良好(N=65,存活)、预后不良(N=37,病死),分析不同病情程度、不同预后患者临床数据;分析血清CRP、PCT水平与SOFA评分、APACHEⅡ评分的相关性,并分析其对G-血流感染脓毒症患者预后不良的预测价值。结果入院后24 h、入院后48 h、入院后7 d、入院后14 d脓毒症休克组血清CRP、PCT水平、APACHEⅡ评分、SOFA评分均高于脓毒症组,预后良好组均较预后不良组低,差异有统计学意义(P<0.05);血清CRP、PCT水平与APACHEⅡ、SOFA评分均呈正相关关系,差异有统计学意义(P<0.05);入院后14 d血清CRP、PCT联合预测G-血流感染脓毒症患者预后不良的AUC值为0.917(95%CI:0.852~0.957),敏感度89.19%、特异度89.23%均较高,差异有统计学意义(P<0.05)。结论血清CRP、PCT水平与G-血流感染脓毒症患者病情、器官功能衰竭联系密切,动态监测血清CRP、PCT水平可反映患者预后,对临床治疗、预后改善具有指导意义。

Objective To dynamically monitor the levels of serum C-reactive protein(CRP)and procalcitonin(PCT)in patients with gram-negative(G-)bloodstream infection with sepsis,and to analyze their application value in the assessment of patients’condition.Methods A total of 102 patients with sepsis with G-bloodstream infection who were admitted to our hospital from January 2019 to December 2020 were selected and divided into sepsis group(N=68)and septic shock group(N=34)according to the severity of the disease.The levels of serum CRP and PCT were detected at 24 h,48 h,7 d and 14 d after admission.Sequential organ failure(SOFA)score and acute physiology and chronic HealthⅡ(APACHEⅡ)score were evaluated at the same time.(N=65,Survival),poor prognosis(N=37,disease and death).Clinical data of patients with different disease degrees and different prognosis were analyzed.To analyze the correlation of serum CRP and PCT levels with SOFA score and APACHEⅡscore,and their predictive value for poor prognosis in patients with G-bloodstream infection sepsis.Results The levels of serum CRP,PCT,APACHEⅡscore and SOFA score in the septic shock group at 24 h,48 h,7 d,and 14 d after admission were higher than those in the sepsis group,and those in the good prognosis group were lower than those in the poor prognosis group(P<0.05);Serum CRP and PCT levels were positively correlated with APACHE II and SOFA scores,and the differences were statistically significant(P<0.05);The AUC value of serum CRP and PCT combined to predict the poor prognosis of patients with G-bloodstream infection sepsis 14 days after admission was 0.917(95%CI:0.852~0.957),with high sensitivity of 89.19%and specificity of 89.23%(P<0.05).Conclusion Serum CRP and PCT levels are closely related to the condition and organ failure of patients with G-bloodstream infection sepsis.Dynamic monitoring of serum CRP and PCT levels can reflect the prognosis of patients and has guiding significance for clinical treatment and prognosis improvement.