摘要目的 探讨降钙素原(PCT)及C-反应蛋白(CRP)联合序贯器官衰竭评分(SOFA)对肺部感染致脓毒症老年患者预后的评估价值.方法 采用回顾性研究方法,选择2015年10月至2018年12月广东省中医院收治的肺部感染致脓毒症老年患者(年龄＞60岁)为研究对象.记录患者入院24 h内PCT、C-反应蛋白、SOFA评分以及28 d预后,根据病情严重程度及28 d预后分组,比较各组的指标差异;绘制受试者工作特征曲线(ROC),分析上述指标单独或联合应用对肺部感染致脓毒症老年患者预后的评估价值.结果 共纳入265例患者,根据病情严重程度分为脓毒症组(194例)和脓毒性休克组(71例);根据28 d预后分为存活组(186例)和死亡组(79例).脓毒性休克组患者PCT、CRP、SOFA评分均明显高于脓毒症组〔PCT(μg/L):6.16(1.94,19.60)比1.56(0.34,7.32),CRP(mg/L):128.90(54.93,198.70)比91.45(30.15,175.30),SOFA评分(分):9.0(7.0,12.0)比4.0(3.0,5.0)〕,差异均有统计学意义(均P＜0.05).死亡组患者PCT、CRP、SOFA评分均明显高于存活组〔PCT(μg/L):4.80(1.06,19.60)比1.82(0.34,7.24),CRP(mg/L):135.20(58.10,225.50)比91.45(31.50, 172.53),SOFA评分(分):7.0(4.0,11.0)比4.0(3.0,6.0)〕,差异均有统计学意义(均P＜0.01).ROC曲线分析显示, PCT、CRP、SOFA评分、CRP+PCT+SOFA评分的ROC曲线下面积(AUC)分别为0.641、0.607、0.697、0.712,说明各项指标对肺部感染致脓毒症老年患者28 d预后均有一定预测价值,以三者联合预测价值最大,其敏感度为55.1%,特异度为80.1%.结论 PCT、CRP、SOFA评分是评估肺部感染致脓毒症老年患者预后的常用指标,三者联合应用具有更高的评估价值.

abstractsObjective To investigate the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) combined with sequential organ failure assessment (SOFA) score in elderly patients with sepsis induced by pulmonary infection. Methods A retrospective study was conducted. The elderly patients aged over 60 years old with sepsis induced by pulmonary infection admitted to Guangdong Provincial Hospital of Chinese Medicine from October 2015 to December 2018 were enrolled. The PCT, CRP and SOFA scores of patients within 24 hours after admission and 28-day prognosis were recorded. The patients were divided into groups according to the severity of the disease and 28-day prognosis. The differences in above parameters among all the groups were compared. Receiver operator characteristic (ROC) curve was drawn to analyze the prognostic value of the above indicators in elderly patients with sepsis induced by pulmonary infection alone or in combination. Results A total of 265 patients were enrolled in the study. According to the severity of the disease, the patients were divided into sepsis group (n = 194) and septic shock group (n = 71). According to the 28-day prognosis, the patients were divided into survival group (n = 186) and non-survival group (n = 79). Compared with the sepsis group, the PCT, CRP and SOFA scores of patients in the septic shock group were significantly increased [PCT (μg/L): 6.16 (1.94, 19.60) vs. 1.56 (0.34, 7.32), CRP (mg/L): 128.90 (54.93, 198.70) vs. 91.45 (30.15, 175.30), SOFA score: 9.0 (7.0, 12.0) vs. 4.0 (3.0, 5.0)] with significant differences (all P < 0.05). Compared with the survival group, the PCT, CRP and SOFA scores of sepsis patients in the non-survival group were significantly increased [PCT (μg/L): 4.80 (1.06, 19.60) vs. 1.82 (0.34, 7.24), CRP (mg/L): 135.20 (58.10, 225.50) vs. 91.45 (31.50, 172.53), SOFA score: 7.0 (4.0, 11.0) vs. 4.0 (3.0, 6.0)] with significant differences (all P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) of PCT, CRP, SOFA score and CRP+PCT+SOFA score was 0.641, 0.607, 0.697, and 0.712, indicating that above parameters had certain predictive value for 28-day prognosis of elderly patients with sepsis induced by pulmonary infection, and the combined predictive value of them was the greatest with the sensitivity of 55.1% and the specificity of 80.1%. Conclusion PCT, CRP and SOFA score are commonly used to evaluate the prognosis of the elderly patients with sepsis induced by pulmonary infection, and the combination of them has higher evaluation value.