血清降钙素原联合皮特菌血症评分对泛耐药肺炎克雷伯菌血流感染患者生存状况的预测效果

Prognostic effect of serum calcitonin combined with Pitt bacteremia score on survival status of patients with extensively drug-resistant Klebsiella pneumoniae bloodstream infection

目的 分析血清降钙素原(PCT)联合皮特菌血症评分(PBS)对泛耐药肺炎克雷伯菌(XDR-KP)血流感染患者生存状况的预测效果。方法 对2021年1月至2022年12月期间郑州市第一人民医院收治的162例XDR-KP血流感染患者展开回顾性分析,所有患者均随访1个月,依据其生存情况分为死亡组(n=99)和存活组(n=63)。比较两组患者的各项一般资料和临床资料,对有统计学意义的进一步行Logistic多因素分析明确XDR-KP血流感染患者死亡的危险因素,并绘制受试者工作特征(ROC)曲线分析PCT联合PBS评分对XDR-KP血流感染患者生存状况的预测效果。结果 死亡组患者PBS≥4分、急性生理与慢性健康(APACHEⅡ)评分≥15分、序贯器官衰竭(SOFA)评分≥5分、入院至血培养时间<30 d、机械通气、持续肾脏替代治疗、抗生素治疗、PCT≥5 ng/mL、感染性休克、入住重症监护室(ICU)的占比高于存活组,死亡组患者的白细胞计数(WBC)水平高于存活组,血小板计数(PLT)水平低于存活组,差异有统计学意义(P<0.05)。PCT≥5 ng/mL、PBS≥4分为XDR-KP血流感染患者死亡的危险因素(P<0.05)。PCT水平、PBS评分对XDR-KP血流感染患者生存状况均有一定的预测价值,且联合应用预测效果更佳。结论 PCT≥5 ng/mL、PBS≥4分为XDR-KP血流感染患者死亡的危险因素,且二者联合应用对患者死亡有较佳的预测价值。

【Objective】To analyze the predictive effect of serum calcitonin(PCT)combined with Pitt bacteremia score(PBS)on the survival status of patients with extensively drug-resistant Klebsiella pneumoniae(XDR-KP)bloodstream infection.【Methods】A retrospective analysis was conducted on 162 cases of XDR-KP bloodstream infection admitted to the First People's Hospital of Zhengzhou from January 2021 to December 2022.All patients were followed up for 1 month and were divided into a death group(n=99)and a survival group(n=63)based on their survival status.The general and clinical data of two groups of patients were compared,the risk factors for death in XDR-KP bloodstream infection patients were identifyed through statistically significant logistic multivariate analysis,and the predictive effect of PCT combined with PBS score on the survival status of XDR-KP bloodstream infection patients was analyzed through the receiver operating characteristic(ROC)curve analysis.【Results】The proportion of patients in the death group with PBS≥4,Acute Physiology and Chronic Health(APACHE II)score≥15,sequential organ failure(SOFA)score≥5,admission to blood culture time<30 d,mechanical ventilation,continuous renal replacement therapy,antibiotic treatment,PCT≥5 ng/mL,septic shock,and admission to intensive care unit(ICU)was higher than that in the survival group.The white blood cell count(WBC)level of patients in the death group was higher than that in the survival group,the platelet count(PLT)level was lower than that of the survival group,and the difference was statistically significant(P<0.05).PCT≥5 ng/mL and PBS≥4 are risk factors for death in XDR-KP bloodstream infection patients(P<0.05).The PCT level and PBS score have certain predictive value for the survival status of XDR-KP bloodstream infection patients,and the combined application has better predictive effect.【Conclusion】PCT≥5 ng/mL and PBS≥4 are risk factors for mortality in XDR-KP bloodstream infection patients,and the combination of the two has better predictive value for patient mortality.