PCT和hs-CRP联合临床肺部感染评分对老年重症肺炎患者预后评估的价值

Value of PCT and hs-CRP Combined with Clinical Pulmonary Infection Scorein Prognosis Evaluation of Elderly Patients with Severe Pneumonia

目的:观察血清降钙素原(PCT)和超敏C反应蛋白(hs-CRP)联合临床肺部感染评分(CPIS)对老年重症肺炎患者(SP)预后评估的临床价值。方法:选取2020年4月至2022年3月我院收治的老年重症肺炎患者92例作为重症组,另外选取同期普通肺炎老年患者30例作为普通组以及同期健康体检无重大疾病的老年人30例作为对照组,比较三组血清PCT、hs-CRP水平以及CPIS情况。根据老年SP患者入院治疗后1个月内的生存情况,将重症组进一步分为存活组和病死组,观察不同预后患者血清PCT、hs-CRP水平以及CPIS,并采用受试者工作特征(ROC)曲线分析血清PCT、hs-CRP联合CPIS对老年SP患者预后的预测价值。结果:入院时重症组血清PCT、hs-CRP水平均显著高于普通组与对照组(P<0.05),CPIS显著高于普通组(P<0.05),重症组患者中,与存活组相比,病死组的血清PCT、hs-CRP水平以及CPIS均明显升高,且病死组各项指标水平均显著高于存活组(P<0.05),ROC特征曲线结果显示血清PCT最佳截断值为9.595ng/mL,hs-CRP最佳截断值为17.615mg/L,CPIS最佳截断值为8.175分,对老年SP患者预后均具有一定程度的诊断价值(P<0.05),且三者并联预测老年SP患者预后的敏感度现显著高于单一指标诊断(P<0.05)。结论:老年SP患者与普通肺炎患者及健康老年人群相比,其血清PCT、hs-CRP以及CPIS水平更高,三者联合检测对老年SP患者预后具有较高的评估价值,建议临床密切监测。

Objective:To observe the clinical value of serum procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP)combined with clinical pulmonary infection score(CPIS)in prognosis evaluation of elderly patients with severe pneumonia(SP).Methods:This study included 92 elderly patients with severe pneumonia(severe group)and 30 elderly patients with ordinary pneumonia(ordinary group)who were admitted to the hospital from April 2020 to March 2022,and 30 elderly patients without major diseases(control group).Serum PCT and hs-CRP levels,and CPIS were compared among the groups.According to the survival status within 1 month after admission,patients in the severe group were divided into a survival group and a death group.Serum PCT and hs-CRP levels,and CPIS in patients with different prognoses were observed.The receiver operating characteristic(ROC)curve was used to analyze the prognostic value of serum PCT,and hs-CRP combined with CPIS in elderly patients with SP.Results:Serum PCT and hs-CRP levels,and CPIS in the severe group at admission were significantly higher than those in the ordinary group and the control group(P<0.05).Serum PCT and hs-CRP levels,and CPIS in the death group were significantly higher than those in the survival group(P<0.05).ROC curve analysis showed that the best cut-off values of serum PCT,hs-CRP,and CPIS were 9.595ng/mL,17.615mg/L,and 8.175.All three could be used for the prognosis of elderly patients with SP(P<0.05).The sensitivity of the combination of the three in the prognosis of elderly patients with SP was higher than that of each index(P<0.05).Conclusion:Compared with patients with ordinary pneumonia and healthy elderly people,elderly patients with SP have higher serum PCT and hs-CRP levels,and higher CPIS.Combined detection of the three is of high value in the prognosis of elderly patients with SP.Therefore,close monitoring of the three indicators is recommended in clinical practice.