PCT、hs-CRP、D-D在评估血流感染严重程度及预后不良中的应用价值

The application value of PCT,hs-CRP and D-D in evaluating the severity and poor prognosis of bloodstream infection

目的探讨炎症指标降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、D-二聚体(D-D)在血流感染严重程度及预后不良中的应用价值。方法选取2019年2月至2021年9月该院收治的254例血流感染患者作为研究对象。根据临床资料将其分为菌血症组(81例)、脓毒血症组(109例)、脓毒性休克组(64例)。再根据预后情况将其分为存活组(207例)和死亡组(47例)。检测并比较菌血症组、脓毒血症组和脓毒性休克组,以及存活组和死亡组PCT、hs-CRP及D-D水平。绘制受试者工作特征(ROC)曲线分析PCT、hs-CRP及D-D对血流感染患者预后不良的预测价值。结果脓毒性休克组的PCT、hs-CRP及D-D水平均高于脓毒血症组和菌血症组,且脓毒血症组均高于菌血症组,差异均有统计学意义(P<0.05)。与存活组比较,死亡组中PCT、hs-CRP及D-D水平均明显升高,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,PCT、hs-CRP及D-D单独预测血流感染预后不良的曲线下面积(AUC)分别为0.739、0.769、0.858。PCT联合hs-CRP、hs-CRP联合D-D、PCT联合D-D预测血流感染预后不良的AUC分别为0.787、0.870、0.856。3项指标联合预测血流感染预后不良的AUC为0.870。结论PCT、hs-CRP、D-D可作为预测血流感染患者预后不良的生物标志物,3项指标联合预测血流感染患者预后不良的价值更高。

Objective To investigate the application value of procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP)and D-dimer(D-D)in evaluating the severity and poor prognosis of bloodstream infection.Methods A total of 254 patients with bloodstream infection admitted to our hospital from February 2019 to September 2021 were selected as the research objects.According to the clinical data,the patients were divided into bacteremia group(81 cases),sepsis group(109 cases),and septic shock group(64 cases).According to the prognosis,all patients were divided into survival group(207 cases)and death group(47 cases).The levels of PCT,hs-CRP and D-D in the bacteremia group,sepsis group and septic shock group were detected and compared,and the levels of PCT,hs-CRP and D-D in the survival group and the death group were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of PCT,hs-CRP and D-D for the poor prognosis of patients with bloodstream infection.Results The levels of PCT,hs-CRP and D-D in septic shock group were higher than those in sepsis group and bacteremia group,and those in sepsis group were higher than those in bacteremia group,and the differences were statistically significant(P<0.05).Compared with the survival group,the levels of PCT,hs-CRP and D-D in the death group were significantly increased,and the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of PCT,hs-CRP and D-D in predicting the poor prognosis of bloodstream infection was 0.739,0.769 and 0.858 respectively.The AUC of PCT combined with hs-CRP,hs-CRP combined with D-D,PCT combined with D-D in predicting the poor prognosis of bloodstream infection were 0.787,0.870 and 0.856 respectively.The AUC of the combination of the three indicators for predicting the poor prognosis of bloodstream infection was 0.870.Conclusion PCT,hs-CRP and D-D can be used as biomarkers to predict the poor prognosis of patients with bloodstream infection,and the combination of the three indicators has higher value in predicting the prognosis of patients with bloodstream infection.