高敏C-反应蛋白与白蛋白比值对呼吸机相关性肺炎病人短期内撤机的预测价值

Predictive value of the ratio of high-sensitivity C-reactive protein to albumin for short-term withdrawal of patients with ventilator-associated pneumonia

目的探究高敏C-反应蛋白(hs-CRP)与白蛋白(Alb)比值对呼吸机相关性肺炎(VAP)病人短期内撤机的预测价值。方法回顾性分析2018年3月至2020年9月河北省人民医院收治的200例VAP病人的临床资料,根据VAP发生时间的早晚分为早发组(100例,机械通气时间≤4 d)和晚发组(100例,机械通气时间>4 d)。采用酶联免疫吸附法(ELISA)检测血清白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、hs-CRP、Alb水平,并计算hs-CRP/Alb比值;利用受试者操作特征曲线(ROC曲线)分析hs-CRP、Alb、hs-CRP/Alb比值对VAP病人短期内撤机的预测价值;采用Kaplan-Meier法绘制以hs-CRP/Alb比值截断值分组的VAP病人短期内撤机率。结果早发组机械通气时间[(5.22±1.68)d]和ICU入住时间[(7.19±1.82)d]高于晚发组[(3.60±1.10)d、(5.31±1.37)d](P<0.05)。与晚发组[(18.13±4.56)μg/L、(55.04±13.57)μg/L、(25.54±4.57)mg/L、(33.31±4.38)g/L]比较,早发组IL-8[(20.82±5.51)μg/L]、TNF-α[(61.41±14.04)μg/L]、hs-CRP[(28.41±5.04)mg/L]显著升高,Alb水平[(30.37±3.35)g/L]显著降低(P<0.05);早发组hs-CRP/Alb比值(0.93±0.25)高于晚发组(0.76±0.12)(P<0.05)。ROC曲线显示,hs-CRP、Alb、hs-CRP/Alb比值预测VAP病人短期内撤机的AUC 95%CI分别为0.72(0.62,0.82)、0.79(0.70,0.88)、0.91(0.85,0.97),灵敏度分别为78.05%、68.38%、80.38%,特异度分别为50.00%、74.00%、96.00%。低hs-CRP/Alb比值组病人短期内撤机率82.03%明显高于高hs-CRP/Alb比值组58.33%(P<0.05)。结论hs-CRP/Alb比值对VAP病人短期内撤机的预测价值较高,可作为参考指标。

Objective To investigate the predictive value of the ratio of high-sensitivity C-reactive protein(hs-CRP)to albumin(Alb)on the short-term withdrawal of patients with ventilator-associated pneumonia(VAP).Methods A retrospective analysis was conducted on the clinical data of 200 VAP patients admitted to Hebei General Hospital from March 2018 to September 2020.According to the occurrence time of VAP,they were divided into an early-onset group(100 cases with mechanical ventilation time≤4 d)and a lateonset group(100 cases with mechanical ventilation time>4 d).Serum interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),hs-CRP and Alb levels were measured by enzyme-linked immunosorbent assay(ELISA),and the hs-CRP/Alb ratio was calculated.The predictive value of hs-CRP,Alb,and the hs-CRP/Alb ratio on the short-term withdrawal of VAP patients was analyzed using subject operating characteristic curves(ROC curves).The Kaplan-Meier method was used to plot the short-term withdrawal probability of VAP patients grouped by the cutoff values of the hs-CRP/Alb ratio.Results The duration of mechanical ventilation[(5.22±1.68)d]and ICU admission[(7.19±1.82)d]in the early-onset group were higher than those in the late-onset group[(3.60±1.10)d,(5.31±1.37)d](P<0.05).Compared with the late-onset group[(18.13±4.56)μg/L,(55.04±13.57)μg/L,(25.54±4.57)mg/L,(33.31±4.38)g/L],the early-onset group had significantly higher IL-8[(20.82±5.51)μg/L],TNF-α[(61.41±14.04)μg/L],and hs-CRP[(28.41±5.04)mg/L]levels and significantly lower Alb levels[(30.37±3.35)g/L]were significantly lower(P<0.05).The hs-CRP/Alb ratio was higher in the early-onset group(0.93±0.25)than in the late-onset group(0.76±0.12)(P<0.05).The ROC curve showed that the AUC 95%CI for hs-CRP,Alb,and hs-CRP/Alb ratio to predict short-term withdrawal in VAP patients were 0.72(0.62,0.82),0.79(0.70,0.88),and 0.91(0.85,0.97),respectively,with sensitivities of 78.05%,68.38%,and 80.38%and specificities of 50.00%,74.00%,and 96.00%,respectively.The short-term withdrawal rate of patients in the low hs-CRP/Alb ratio group was 82.03%,which was significantly higher than that in the high hs-CRP/Alb ratio group(58.33%)(P<0.05).Conclusion The hs-CRP/Alb ratio has a higher predictive value for short-term withdrawal in VAP patients and can be used as a reference indicator.