PCT/Alb对老年社区获得性肺炎患者病情严重程度及预后的预测价值

The Predictive Value of Procalcitonin to Albumin Ratio in the Severity and Prognosis of Elderly Patients with Community-acquired Pneumonia

目的探讨降钙素原(procalcitonin,PCT)与白蛋白(albumin,Alb)比值(PCT/Alb,即PAR)对老年社区获得性肺炎(community acquired pneumonia,CAP)患者病情严重程度及预后的预测价值。方法对2018年1月~2021年4月于徐州医科大学附属医院住院治疗的489例老年CAP患者的临床资料进行回顾性分析。根据2007年IDSA/ATS制定的《社区获得性肺炎诊断及治疗指南》中对重症社区获得性肺炎(severe community acquired pneumonia,SCAP)的诊断标准,将患者分为非重症组(n=297)与重症组(n=192),同时根据SCAP患者28天内死亡情况分为死亡组(n=73)与存活组(n=119),比较各组间一般资料(年龄、性别、基础疾病史等)、CURB-65评分、PAR、白细胞计数(white blood Cell,WBC)、中性粒细胞百分比(neutrophil percentage,Neu%)、C反应蛋白(C-reactive protein,CRP)及红细胞沉降率等有无差异,采用Logistic回归分析预测PAR与患者28天内病死率的关系,绘制受试者工作特征(ROC)曲线来识别PAR临界点。结果重症组PAR水平均明显高于非重症组(P<0.05),死亡组PAR水平均明显高于存活组,差异均有统计学意义(P均<0.05)。Logistic回归分析显示,PAR为SCAP患者死亡的危险因素,PAR在预测患者28天内病死率的ROC曲线下面积为0.755,阈值为0.1673(特异性为74.8%,敏感度为67.1%,P<0.001)。结论PAR对老年CAP患者的病情严重程度及预后有临床预测价值,PAR越高,病情越严重,病死率越高。

Objective To investigate the predictive value of procalcitonin(PCT)to albumin(Alb)ratio(PCT/Alb,PAR)on the severity of disease and prognosis of elderly patients with community acquired pneumonia(CAP).Methods A retrospective analysis was performed in elderly CAP patients(489 cases)hospitalized at the Affiliated Hospital of Xuzhou Medical University from January 2018 to April 2021.According to the diagnostic criteria of the 2007 IDSA/ATS Guidelines for the diagnosis and treatment of community acquired pneumonia(CAP)for severe community acquired pneumonia(SCAP),the patients were divided into a non-severe group(297 cases)and a severe group(192 cases),and the SCAP patients were also divided into a death group(73 cases)and a survival group(119 cases)according to the result within 28days.general information(age,gender,history of underlying disease,etc.),CURB-65 score,PAR,white blood cell(WBC),neutrophil percentage(Neu%),C-reactive protein(CRP)and blood sedimentation were compared between groups,and logistic regression analysis was used to predict the relationship between PAR and patient mortality within 28 days,and subject work characteristics(ROC)were plotted curves to identify PAR thresholds.Results PAR levels were significantly higher in the severe group than in the non-severe group(P<0.05),PAR levels were significantly higher in the death group than in the survival group,and all differences were statistically significant(P<0.05).Logistic regression analysis showed that PAR was a risk factor for death in SCAP patients,and the area under the ROC curve for PAR in predicting mortality within 28 days was 0.755 with a threshold of 0.1673(specificity:74.8%,sensitivity:67.1%,P<0.001).Conclusion PAR has clinical predictive value for the severity and prognosis of elderly CAP patients,with higher PAR associated with more severe disease and higher mortality.