降钙素原对社区获得性肺炎死亡率及病情评估的价值

摘要

Objective To study the value of procalcitonin (PCT) level in predicting mortality and severity of community-acquired pneumonia (CAP) in the emergency department. Methods The general clinical data and in-flammatory biomarker of 114 patients with CAP were collected. The severity of CAP was assessed by PSI and CURB65 score. An analysis was performed to assess the value of PCT, WBC counts, high-sensitivity C-reactive pro-tein (hs-CRP), and erythrocyte sedimentation rate (ESR) for the prediction of mortality and severity. Results 14 high-risk patients died within 28 days. Compared with the survival group, the death group had significantly increased PCT level (2. 96 ± 1. 54 vs 0. 38 ± 0. 24 ng/ mL, P < 0. 01) and hs-CRP(194. 61 ± 72. 80 vs 101. 26 ± 65. 98 mg/ L, P < 0. 01). The PCT level was significantly higher in the severe group than in the moderate group according to PSI and CURB65 score. Through logistic regression analyses, the area under the receiver operating characteristic curve (ROC) of PCT level were 0. 81. The area under ROC increased significantly while it used PCT combined with PSI and CURB65 score to predict the mortality and severity of CAP. Conclusion The level of PCT is a more versatile tool for predicting mortality and severity of CAP in the emergence department, and the level of procalcitonin as an ad-junct to CAP prediction rules may be valuable for prognosis and severity assessment.%目的：探索降钙素原(PCT)对社区获得性肺炎(CAP)患者的死亡率和病情评估的价值。方法前瞻性研究在急诊科通过症状和 X 线检查诊断为 CAP 的114例患者,收集患者的一般临床资料及炎症标志物。采用肺炎严重性指数(PSI)、CURB65评分评估 CAP 患者的疾病严重性,分析血沉(ESR)、白细胞计数、高敏 C 反应蛋白(Hs-CRP)及 PCT 预测 CAP 患者死亡率和疾病严重性的价值。结果114例患者中14例高危患者28天内死亡。死亡组较存活组 PCT 和 Hs-CRP 水平显著增高(2．96±1．54比0．38±0．24 ng/ mL,P<0．05)(194．61±72．80比101．26±65．98 mg/ L),依据 PSI 和 CURB65评分系统对疾病严重性的评估结果,病情严重患者 PCT 水平显著升高。逻辑回归分析表明,PCT 水平预测 CAP 死亡率 ROC 曲线下面积为0．81, PCT 水平结合 PSI 和 CURB65评分来预测 CAP 患者的疾病严重性,ROC 曲线下面积显著增加。结论 PCT水平能很好预测急诊 CAP 患者的死亡率和病情的严重性,PCT 水平结合 PSI 和 CURB65评分,更有利于评估预后和病情严重性。