NT-ProBNP、sTREM-1及APACHE Ⅱ评分对老年重症肺炎患者预后评估的价值
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摘要
目的:探讨血清N末端脑钠肽前体(NT-ProBNP)、可溶性髓系细胞触发受体1(sTREM-1)水平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(SP)患者的预后评估价值。方法:选取我院收治的老年SP患者208例进行前瞻性研究,检测患者第1、3、5天血清NT-ProBNP及sTREM-1水平变化,记录APACHEⅡ评分及预后情况。应用受试者工作特征(ROC)曲线分析血清NT-ProBNP、sTREM-1及APACHEⅡ评分对老年SP患者的预后价值,采用Logistic回归分析老年SP患者发生死亡的独立预测因素。结果:死亡组第1、3、5天血清NT-ProBNP(2 864.50±537.60 vs 1 146.30±318.42,4 205.63±738.52 vs 986.20±204.37,6317.45±912.64 vs 674.35±125.40,pg/mL)、sTREM-1(68.42±14.25 vs 54.28±10.13,76.20±17.60 vs 43.50±7.36,82.42±19.35 vs 40.72±7.50,pg/mL)及APACHEⅡ评分(24.80±4.50 vs 20.30±3.25,29.74±5.63 vs 18.26±3.14,35.82±6.12 vs 16.84±3.06,分)均明显高于存活组(均P<0.05)。Logistic回归分析显示,NT-ProBNP[OR=1.503(1.363～2.106)]、sTREM-1[OR=1.914(1.527～2.508)]及APACHEⅡ评分[OR=1.226(1.078～1.636)]升高是老年SP患者预后不良的独立影响因素(均P<0.05)。ROC曲线显示,第3天血清NT-ProBNP、sTREM-1及APACHEⅡ评分预测老年SP患者死亡的最佳截值分别为3 016.40 pg/mL、69.34 pg/mL和25.83分,三项联合预测老年SP患者死亡的AUC(95%CI)为0.962(0.925～0.998),其敏感度(98.0%)和特异度(89.5%)最高。结论:血清NT-ProBNP、sTREM-1及APACHEⅡ评分变化与老年SP患者病情严重程度及预后相关,第3天三项联合预测患者预后的价值最大。
Objective: To evaluate the prognostic value of serum N-terminal pro-brain natriuretic peptide(NT-ProBNP) levels, soluble triggering receptor expressed on myeloid cells-1(sTREM-1) levels and acute physiological and chronic health status score system Ⅱ(APACHE Ⅱ) scores in predicting the prognosis of elderly patients with severe pneumonia(SP). Method: A prospective study was conducted in 208 elderly patients with SP in Third people's Hospital of Hainan Province. The changes of serum NT-ProBNP and sTREM-1 levels were detected on the first, third and fifth days, and the score of APACHE Ⅱ and the prognosis were recorded. The value of serum NT-ProBNP, sTREM-1 and APACHE Ⅱ scores on the prognosis of elderly SP was analyzed with the ROC curve, and the independent predictors of death in elderly SP patients were analyzed by Logistic regression. Result: The serum NT-ProBNP(2 864.50±537.60 vs 1 146.30±318.42, 4205.63±738.52 vs 986.20±204.37, 6317.45±912.64 vs 674.35±125.40, pg/mL), sTREM-1(68.42±14.25 vs 54.28±10.13, 76.20±17.60 vs 43.50±7.36, 82.42±19.35 vs 40.72±7.50, pg/mL) and APACHE Ⅱ scores(24.80±4.50 vs 20.30±3.25, 29.74±5.63 vs 18.26±3.14, 35.82±6.12 vs 16.84±3.06, score) on the first, third and fifth days of the death group were significantly higher than those in the survival group(all were P<0.05). Logistic regression analysis showed that NT-ProBNP[OR=1.503(1.363-2.106) ], sTREM-1[OR=1.914(1.527-2.508) ]and APACHE Ⅱ score[OR=1.226(1.078-1.636) ]were independent factors of poor prognosis in elderly SP patients(all were P<0.05). The ROC curve showed that the best cut-off values of serum NT-ProBNP, sTREM-1 and APACHE Ⅱ score on the third day to predict death in elderly SP patients were 3 016.40 pg/mL, 69.34 pg/mL and 25.83 score, respectively. The three combined prediction of AUC(95%CI) for elderly SP patients was 0.962(0.925-0.998), and its sensitivity(98%) and specificity(89.5%) were the highest. Conclusion: The changes of serum NT-ProBNP, sTREM-1 and APACHE Ⅱ scores were related to the severity and prognosis of the elderly patients with SP, and on the third day those three items combined to predict the prognosis of the patients is the most valuable.
Objective: To evaluate the prognostic value of serum N-terminal pro-brain natriuretic peptide(NT-ProBNP) levels, soluble triggering receptor expressed on myeloid cells-1(sTREM-1) levels and acute physiological and chronic health status score system Ⅱ(APACHE Ⅱ) scores in predicting the prognosis of elderly patients with severe pneumonia(SP). Method: A prospective study was conducted in 208 elderly patients with SP in Third people's Hospital of Hainan Province. The changes of serum NT-ProBNP and sTREM-1 levels were detected on the first, third and fifth days, and the score of APACHE Ⅱ and the prognosis were recorded. The value of serum NT-ProBNP, sTREM-1 and APACHE Ⅱ scores on the prognosis of elderly SP was analyzed with the ROC curve, and the independent predictors of death in elderly SP patients were analyzed by Logistic regression. Result: The serum NT-ProBNP(2 864.50±537.60 vs 1 146.30±318.42, 4205.63±738.52 vs 986.20±204.37, 6317.45±912.64 vs 674.35±125.40, pg/mL), sTREM-1(68.42±14.25 vs 54.28±10.13, 76.20±17.60 vs 43.50±7.36, 82.42±19.35 vs 40.72±7.50, pg/mL) and APACHE Ⅱ scores(24.80±4.50 vs 20.30±3.25, 29.74±5.63 vs 18.26±3.14, 35.82±6.12 vs 16.84±3.06, score) on the first, third and fifth days of the death group were significantly higher than those in the survival group(all were P<0.05). Logistic regression analysis showed that NT-ProBNP[OR=1.503(1.363-2.106) ], sTREM-1[OR=1.914(1.527-2.508) ]and APACHE Ⅱ score[OR=1.226(1.078-1.636) ]were independent factors of poor prognosis in elderly SP patients(all were P<0.05). The ROC curve showed that the best cut-off values of serum NT-ProBNP, sTREM-1 and APACHE Ⅱ score on the third day to predict death in elderly SP patients were 3 016.40 pg/mL, 69.34 pg/mL and 25.83 score, respectively. The three combined prediction of AUC(95%CI) for elderly SP patients was 0.962(0.925-0.998), and its sensitivity(98%) and specificity(89.5%) were the highest. Conclusion: The changes of serum NT-ProBNP, sTREM-1 and APACHE Ⅱ scores were related to the severity and prognosis of the elderly patients with SP, and on the third day those three items combined to predict the prognosis of the patients is the most valuable.
引文
[1] Pieralli F,Vannucchi V,De Marzi G,et al.Performance status and in-hospital mortality of elderly patients with community acquired pneumonia[J].Intern Emerg Med,2018,13(4):501-507.
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[9] 秦珊,何先弟,汪华学.外周血PCT IL-17及sTREM-1检测在呼吸机相关性肺炎早期诊断中的价值[J].中国急救医学,2017,37(5):427-432.
[10] Esposito S,Di Gangi M,Cardinale F,et al.Sensitivity and specificity of soluble triggering receptor expressed on myeloid Cells-1,midregional proatrial natriuretic peptide and midregional proadrenomedullin for distinguishing eiology and to assess severity in community-acquired pneumonia[J].PLoS One,2016,11(11):e0163262.
[11] 刘雪燕,吴伟元,江意春,等.血清sTREM-1对脓毒症诊断及预后评估中的价值研究[J].中国急救医学,2017,37(12):1091-1095.
[12] Chhangani NP,Amandeep M,Choudhary S,et al.Role of acute physiology and chronic health evaluation II scoring system in determining the severity and prognosis of critically ill patients in pediatric intensive care unit[J].Indian J Crit Care Med,2015,19(8):462-465.
[13] Tazón-Varela MA,Alonso-Valle H,Muňoz-Cacho P.The N-terminal pro brain natriuretic peptide as a predictor of mortality in patients with community acquired pneumonia[J].Med Clin(Barc),2018,150(9):366-367.
[14] 董亮,张秀红,梁锋鸣,等.髓样细胞可溶性触发受体-1在呼吸机相关性肺炎预后评估中的价值研究[J].中华急诊医学杂志,2018,27(1):93-98.
[15] Wang H,Li Z,Yin M,et al.Combination of Acute Physiology and Chronic Health Evaluation II score,early lactate area,and N-terminal prohormone of brain natriuretic peptide levels as a predictor of mortality in geriatric patients with septic shock[J].J Crit Care,2015,30(2):304-309.
[16] Charles PE,Noel R,Massin F,et al.Significance of soluble triggering receptor expressed on myeloid cells-1 elevation in patients admitted to the intensive care unit with sepsis[J].BMC Infect Dis,2016,16(1):559.
[2] Cheng H,Fan WZ,Wang SC,et al.N-terminal pro-brain natriuretic peptide and cardiac troponin I for the prognostic utility in elderly patients with severe sepsis or septic shock in intensive care unit:A retrospective study[J].J Crit Care,2015,30(3):654.
[3] Cao C,Gu J,Zhang J.Soluble triggering receptor expressed on myeloid cell-1(sTREM-1):a potential biomarker for the diagnosis of infectious diseases[J].Front Med,2017,11(2):169-177.
[4] Dey S,Karim HMR,Yunus M,et al.Relationship of on Admission Hypocalcaemia and Illness Severity as Measured by APACHE-II and SOFA Score in Intensive Care Patients[J].J Clin Diagn Res,2017,11(3):UC01-UC03.
[5] Cavallazzi R,Wiemken T,Arnold FW,et al.Outcomes in patients with community-acquired pneumonia admitted to the intensive care unit[J].Respir Med,2015,109(6):743-750.
[6] García Villalba E,Bernal Morell E,Egea MP,et al.The N-terminal pro brain natriuretic peptide is the best predictor of mortality during hospitalization in patients with low risk of sepsis-related organ failure[J].Med Clin(Barc),2017,149(5):189-195.
[7] Jeong KY,Kim K,Kim TY,et al.Prognostic value of N-terminal pro-brain natriuretic peptide in hospitalised patients with community-acquired pneumonia[J].Emerg Med J,2011,28(2):122-127.
[8] 刘道莹,刘笛,尹昆.重症肺炎患者血清NT-proBNP和HMGB1水平的变化及其意义[J].中国现代医学杂志,2017,27(17):58-61.
[9] 秦珊,何先弟,汪华学.外周血PCT IL-17及sTREM-1检测在呼吸机相关性肺炎早期诊断中的价值[J].中国急救医学,2017,37(5):427-432.
[10] Esposito S,Di Gangi M,Cardinale F,et al.Sensitivity and specificity of soluble triggering receptor expressed on myeloid Cells-1,midregional proatrial natriuretic peptide and midregional proadrenomedullin for distinguishing eiology and to assess severity in community-acquired pneumonia[J].PLoS One,2016,11(11):e0163262.
[11] 刘雪燕,吴伟元,江意春,等.血清sTREM-1对脓毒症诊断及预后评估中的价值研究[J].中国急救医学,2017,37(12):1091-1095.
[12] Chhangani NP,Amandeep M,Choudhary S,et al.Role of acute physiology and chronic health evaluation II scoring system in determining the severity and prognosis of critically ill patients in pediatric intensive care unit[J].Indian J Crit Care Med,2015,19(8):462-465.
[13] Tazón-Varela MA,Alonso-Valle H,Muňoz-Cacho P.The N-terminal pro brain natriuretic peptide as a predictor of mortality in patients with community acquired pneumonia[J].Med Clin(Barc),2018,150(9):366-367.
[14] 董亮,张秀红,梁锋鸣,等.髓样细胞可溶性触发受体-1在呼吸机相关性肺炎预后评估中的价值研究[J].中华急诊医学杂志,2018,27(1):93-98.
[15] Wang H,Li Z,Yin M,et al.Combination of Acute Physiology and Chronic Health Evaluation II score,early lactate area,and N-terminal prohormone of brain natriuretic peptide levels as a predictor of mortality in geriatric patients with septic shock[J].J Crit Care,2015,30(2):304-309.
[16] Charles PE,Noel R,Massin F,et al.Significance of soluble triggering receptor expressed on myeloid cells-1 elevation in patients admitted to the intensive care unit with sepsis[J].BMC Infect Dis,2016,16(1):559.
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