血清降钙素原、C-反应蛋白及乳酸对老年脓毒症患者的预后评估

摘要

目的 探讨老年脓毒症患者血清降钙素原(PCT)、C-反应蛋白(CRP)及乳酸水平与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯性器官功能衰竭评估(SOFA)评分的相关性,分析其对脓毒症患者的预后评估价值.方法 选取我院收治的老年脓毒症患者186例,根据其28 d生存情况的随访结果 分为存活组(110例)和死亡组(76例).检测两组患者血清PCT、CRP及乳酸水平变化,并记录入院时APACHEⅡ、SOFA评分情况.采用t检验、重复测量的方差分析、χ2检验或Fisher精确检验对两组数据进行分析.应用受试者工作特征(ROC)曲线分析血清PCT、CRP及乳酸对老年脓毒症患者预后的评估价值.采用Pearson相关分析法分析死亡组血清PCT、CRP及乳酸水平与APACHEⅡ、SOFA评分的相关性.结果死亡组第1、3、7天血清PCT、CRP及乳酸水平均明显高于存活组(P<0.05),且死亡组第7天血清PCT、CRP及乳酸水平明显高于第1、3天(P<0.05).存活组第7天血清PCT、CRP及乳酸水平均明显低于第1、3天(P<0.05).Logistic回归分析发现,PCT、CRP、乳酸及SOFA评分是老年脓毒症患者预后不良的独立影响因素.ROC曲线显示,PCTd3、CRPd3及乳酸d3评估老年脓毒症患者预后的最佳截值分别为9.83μg/L、86.42 mg/L和3.72 mmol/L,其敏感度和特异度较好,分别为81.7％和85.3％,77.5％和79.8％,86.3％和76.2％.相关分析显示,死亡组血清PCTd3与APACHEⅡ评分、SOFA评分的相关性较好(r=0.703,P<0.001;r=0.802,P<0.001).结论 血清PCT、CRP及乳酸水平与老年脓毒症患者的病情严重程度及预后密切相关,第3天血清PCT水平预测患者预后的价值最大.%Objective To investigate the correlation of serum levels of lactate , procalcitonin ( PCT ) , and C-reactive protein ( CRP) with the score of acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ) and sequential organ failure assessment ( SOFA) score in the elderly patients with sepsis , and to analyze the prognostic values of these levels .Methods A total of 186 cases of senile sepsis in our hospital from January 2012 to December 2016 were selected and followed up for 28 d.According to their survival outcomes, they were divided into survival group (n=110) and death group (n=76).The serum levels of PCT, CRP and lactate in the 2 groups were detected, and the scores of APACHE Ⅱand SOFA were recorded.Student's t test, repeated measures analysis of variance, and Chi-square test or Fisher exact test were adopted for the data .Receiver-operating characteristic ( ROC) curve analysis was employed to evaluate the prognostic values of the serum PCT , CRP and lactate levels in the septic elderly .Correlations of serum PCT, CRP and lactate levels with APACHEⅡand SOFA scores were analyzed in the death group by Pearson linear correlation analysis . Results The serum levels of PCT , CRP and lactate in the first , third and seventh days were significantly higher in the death group than in the survival group (P<0.05).What's more, the serum levels in the seventh day of the death group were obviously higher than those of the first and third days (P<0.05), but the levels in the seventh day of the survival group were notably lower than those of the first and third days (P<0.05).Logistic regression analysis found that serum levels of PCT , CRP and lactate, and SOFA score were independent factors for poor prognosis in the elderly patients with sepsis .The ROC curve showed that the best cut-off values of PCTd3, CRPd3 and lactated3 were 9.83 μg/L, 86.42 mg/L and 3.72 mmol/L in the evaluation of prognosis, with the sensitivity and specificity of 81.7％and 85.3％, 77.5％and 79.8％, and 86.3％and 76.2％, respectively.Correlation analysis indicated that the serum PCTd3 level was positively correlated with APACHE Ⅱand SOFA scores in the death group (r=0.703, P<0.001;r=0.802, P<0.001).Conclusion Serum PCT, CRP and lactate levels are closely related to the severity and prognosis of sepsis in elderly patients ,and serum PCT level in the third day shows the greatest predictive value in the prognosis .