降钙素原联合血乳酸水平预测ICU患者谵妄发生的价值

Value of procalcitonin plus blood lactic acid level in predicting occurrence of delirium in ICU patients

目的:探讨降钙素原联合血乳酸(Lac)水平在ICU患者谵妄发生中的预测价值。方法:选择2020年1~12月收住宣城市人民医院ICU的患者,分为谵妄组(n=26)和非谵妄组(n=182),比较两组患者的相关临床资料、炎性指标及Lac水平差异。结果:ICU谵妄发生率为12.5%(26/208),两组患者间性别、年龄、APACHE II评分、有无机械通气、疾病类型差异均无统计学意义(P>0.05)。与非谵妄组比较,谵妄组入住ICU时间更长、电解质紊乱率更高(P<0.05),谵妄组PCT、CRP、IL-6、血Lac水平均增高(P<0.05)。多因素Logistic回归分析显示,PCT、血Lac升高为ICU患者谵妄发生的独立危险因素(P<0.05)。PCT指标ROC曲线下面积(AUC)为0.826(95%CI:0.755~0.897),其灵敏度和特异度分别为92.3%和61.5%;血Lac指标AUC为0.852(95%CI:0.777~0.927),其灵敏度和特异度分别为69.2%和84.1%;两者联合预测谵妄发生的AUC为0.842(95%CI:0.764~0.920),其灵敏度和特异度分别为97.6%和51.7%。结论:PCT联合血Lac水平对预测ICU患者谵妄发生具有重要价值。

Objective:To investigate predictive value of procalcitonin combined with blood lactic acid level(Lac)in ICU patients with delirium.Methods:Patients admitted to ICU of Xuancheng People′s Hospital were included from January 2020 to December 2020,and divided into delirium group(n=26)and non-delirium group(n=182).The two groups of patients were then compared concerning clinical data,inflammatory indicators and blood lactic acid levels.Results:The incidence of delirium was 12.5%(26/208),and there were no significant differences in gender,age,APACHE II score,history of mechanical ventilation or disease type between the 2 groups(P>0.05).Compared with non-delirium group,the length of stay in the ICU was longer and the rate of electrolyte disturbance was higher in delirium group(P<0.05),and patients with delirium had significantly increased levels of PCT,CRP,IL-6 and blood Lac(P<0.05).Multivariate logistic regression analysis showed that elevated PCT and Lac levels were independent risk factors for delirium in ICU patients(P<0.05).The area under ROC curve 0.826 for PCT index(95%CI:0.755-0.897)and 0.852 for Lac(95%CI:0.777-0.927).Diagnostic sensitivity and specificity were 92.3%and 61.5%for the former,and 69.2%and 84.1%for the latter,respectively.The area under ROC curve for predicting delirium occurrence by combined indicators of the two was 0.842(95%CI:0.764-0.920),and the sensitivity and specificity were 97.6%and 51.7%,respectively.Conclusion:Combined PCT with blood Lac level can be valuable to predict occurrence of delirium in ICU patients.