血清PCT、IL-18及APACHEⅡ评分对老年重症肺炎患者预后的评估价值

摘要

目的 探讨血清降钙素原(procalcitonin,PCT)、白细胞介素-18(interleukin-18,IL-18)及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对老年重症肺炎患者预后的评估价值.方法 选取2013年1月-2016年10月海南省中医院收治的老年重症肺炎患者286例,根据其28 d的生存情况分为存活组(203例)和死亡组(83例),比较两组患者第1天、第4天、第7天血清PCT、IL-18水平及APACHEⅡ评分的动态变化.应用多因素Logistic回归分析影响老年重症肺炎患者预后的危险因素,并绘制ROC曲线评估PCT、IL-18及APACHEⅡ评分对老年重症肺炎患者预后的预测价值.PCT与IL-18、APACHEⅡ的相关性分析采用Pearson相关.结果 死亡组血清PCT[(4.69±1.75)ng/ml vs(0.41±0.15)ng/ml]、IL-18[(85.16±20.17)ng/ml vs(68.23±18.56)ng/ml]及APACHEⅡ评分[(27.84±4.63)ng/ml vs(23.87±4.16)ng/ml]均明显高于存活组(P均<0.05).Logistic回归分析发现机械通气、PCT、IL-18及APACHEⅡ评分是老年重症肺炎患者死亡的独立危险因素,其OR及95%CI分别为6.018(2.175~11.974)、2.427(1.359~5.826)、1.805(1.106~4.283)、4.482(1.892~8.747)(P均<0.05).ROC曲线显示,PCT、IL-18及APACHEⅡ评分联合评估对预测老年重症肺炎患者死亡的敏感度和特异度最好,分别为89.4%和81.6%.相关分析显示,死亡组确诊当天血清PCT与IL-18、APACHEⅡ评分均呈正相关(r=0.473,P=0.025;r=0.681,P<0.001).结论 血清PCT、IL-18及APACHEⅡ评分是老年重症肺炎患者死亡的独立危险因素,三项联合检查对预测老年重症肺炎患者预后具有较好的预测价值.%Objective To explore the value of serum procalcitonin (PCT), interleukin-18 (IL-18) and acute physiology and chronic health evaluation (APACHE) score in prognostic prediction to severe pneumonia in elderly patients. Methods Totally 286 elderly patients with severe pneumonia were selected from January 2013 to October 2016 in Hainan Provincial Hospital of traditional Chinese medicine, and divided into survival group (n=203 cases) and death group (n=83 cases) according to the 28-day survival. The dynamic changes of serum PCT, IL-18 levels and APACHE Ⅱ score were compared between the two groups at D1, D4 and D7. Multivariate Logistic regression analysis was used to analyze the risk factors of prognosis in elderly patients with severe pneumonia, and the ROC curve was used to evaluate the predictive value of PCT, IL-18 and APACHE Ⅱ score in the prognosis of elderly patients with severe pneumonia. Correlation analysis of PCT with IL-18 and APACHE was performed by Pearson correlation analysis. Results The serum PCT [(4.69±1.75) ng/ml vs (0.41±0.15) ng/ml, IL-18 (85.16±20.17) ng/ml vs (68.23±18.56) ng/ml and APACHE Ⅱ score (27.84±4.63) ng/ml vs (23.87±4.16) ng/ml] in the death group were significantly higher than those in the survival group (P < 0.05, respectively). Logistic regression analysis showed that mechanical ventilation [OR(95% CI): 6.018 (2.175-11.974)], PCT [OR(95% CI): 2.427 (1.359-5.826)], IL-18[OR(95% CI): 1.805 (1.106-4.283)] and APACHE score [OR(95%CI): 4.482 (1.892 -8.747)] were independent risk factors of death in elderly patients with severe pneumonia (P < 0.05, respectively). ROC curve showed that combination of PCT,IL-18 and APACHE Ⅱ score was most sensitive (89.4%) and specific (81.6%) for predicting mortality in elderly patients with severe pneumonia. Correlation analysis showed that the serum PCT level in death group was positively correlated with IL-18 and APACHE score (r=0.473, P=0.025; r=0.681, P < 0.001). Conclusion Serum PCT, IL-18 and APACHE Ⅱ score are independent risk factors for mortality in elderly patients with severe pneumonia, and combination of three indexes is of good value in predicting the prognosis.