降钙素原及APACHE-Ⅱ、SOFA评估复杂腹腔感染后脓毒性休克预后的价值
|
摘要
目的:探讨降钙素原及APACHE-Ⅱ、SOFA评分评估复杂腹腔感染后脓毒性休克预后的价值。方法:选择2013-01—2018-03在ICU救治的复杂腹腔感染导致脓毒性休克患者83例,根据28 d随访的结果分成存活组35例和死亡组48例。观察2组入院后第1、3、7天PCT水平及APACHE-Ⅱ、SOFA评分。分析PCT水平与APACHE-Ⅱ、SOFA评分的相关性。运用ROC曲线评价PCT水平与APACHE-Ⅱ、SOFA对脓毒性休克预后的预测价值。结果:83例复杂腹腔感染患者共分离出阳性病原菌79株,其中G~-菌51株、G~-菌23株、真菌5株,分别占总菌株数的64.6%、G~+菌29.1%、真菌6.3%。死亡组第1、3、7天PCT水平及APACHE-Ⅱ、SOFA评分均高于存活组(P<0.05)。存活组第7天以上指标较第1、3天明显降低(P<0.05);死亡组第3、7天以上指标较第1天明显升高(P<0.05)。相关性分析显示,PCT水平与第1、3、7天的APACHE-Ⅱ、SOFA评分均呈显著正相关(P<0.05)。ROC曲线分析显示,第1、3天PCT的AUC为0.869、0.893,均高于APACHE-Ⅱ和SOFA评分。结论:与APACHE-Ⅱ及SOFA比较,PCT早期水平能更有效地预测复杂腹腔感染后脓毒性休克预后。
Objective:To investigate the prognostic values of PCT,APACHE-Ⅱscore and SOFA score for septic shock caused by complicated intra-abdominal infections. Method:A total of 83 patients with septic shock caused by complicated intra-abdominal infections was collected between January 2013 and March 2018 in our hospital.The patients were divided into survive group(n=35)and death group(n=48)according to the follow-up results at day 28.PCT levels,APACHE-Ⅱscores and SOFA scores at 1 d,3 d and 7 d after admission were observed in two groups.The correlations of PCT levels with APACHE-Ⅱscores and SOFA scores were analyzed.The predictive values of PCT levels,APACHE-Ⅱscores and SOFA scores for the prognosis of septic shock were evaluated by ROC curve. Result:79 strains of positive pathogenic bacteria were isolated from 83 patients with complex abdominal infection,among which 51 strains of G~-bacteria,23 strains of G~+ bacteria and 5 strains of fungi,accounting for 64.6%,29.1% and 6.3%,respectively.PCT levels,APACHE-Ⅱscores and SOFA scores at 1 d,3 d and 7 d after admission in death group were higher than those in survive group(P<0.05).Compared with those at 1 d,3 d after admission,PCT level,APACHE-Ⅱscore and SOFA score at 7 d after admission decreased in survive group(P<0.05).Compared with those at 1 d after admission,PCT levels,APACHE-Ⅱscores and SOFA scores at 3 d,7 d after admission increased in death group(P<0.05).Correlation analysis showed that the PCT levels were positive correlation with APACHE-Ⅱscores and SOFA scores at 1 d,3 d,7 d(P<0.05).ROC curve analysis showed that AUC of PCT at 1 d,3 d was 0.869 and 0.893,which were higher than that of APACHE-Ⅱ and SOFA score.Conclusion:Compared with those of APACHE-Ⅱscores and SOFA scores,the early levels of PCT can predict the prognosis of septic shock caused by complicated intra-abdominal infections more effectively.
Objective:To investigate the prognostic values of PCT,APACHE-Ⅱscore and SOFA score for septic shock caused by complicated intra-abdominal infections. Method:A total of 83 patients with septic shock caused by complicated intra-abdominal infections was collected between January 2013 and March 2018 in our hospital.The patients were divided into survive group(n=35)and death group(n=48)according to the follow-up results at day 28.PCT levels,APACHE-Ⅱscores and SOFA scores at 1 d,3 d and 7 d after admission were observed in two groups.The correlations of PCT levels with APACHE-Ⅱscores and SOFA scores were analyzed.The predictive values of PCT levels,APACHE-Ⅱscores and SOFA scores for the prognosis of septic shock were evaluated by ROC curve. Result:79 strains of positive pathogenic bacteria were isolated from 83 patients with complex abdominal infection,among which 51 strains of G~-bacteria,23 strains of G~+ bacteria and 5 strains of fungi,accounting for 64.6%,29.1% and 6.3%,respectively.PCT levels,APACHE-Ⅱscores and SOFA scores at 1 d,3 d and 7 d after admission in death group were higher than those in survive group(P<0.05).Compared with those at 1 d,3 d after admission,PCT level,APACHE-Ⅱscore and SOFA score at 7 d after admission decreased in survive group(P<0.05).Compared with those at 1 d after admission,PCT levels,APACHE-Ⅱscores and SOFA scores at 3 d,7 d after admission increased in death group(P<0.05).Correlation analysis showed that the PCT levels were positive correlation with APACHE-Ⅱscores and SOFA scores at 1 d,3 d,7 d(P<0.05).ROC curve analysis showed that AUC of PCT at 1 d,3 d was 0.869 and 0.893,which were higher than that of APACHE-Ⅱ and SOFA score.Conclusion:Compared with those of APACHE-Ⅱscores and SOFA scores,the early levels of PCT can predict the prognosis of septic shock caused by complicated intra-abdominal infections more effectively.
引文
[1] 于湘友,郗晓婧,钟华,等.PCT清除率用于评估ICU脓毒症患者预后的临床研究[J].中华急诊医学杂志,2013,22(2):205-208.
[2] 吴钦良,嵇金陵,张小云.血清降钙素原动态检测对脓毒血症诊断和预后的应用价值分析[J].临床血液学杂志,2018,31(12):901-903.
[3] Suberviola B,Castellanos-Ortega A,González-Castro A,et al.Prognostic value of procalcitonin,C-reactive protein and leukocytes in septic shock[J].Med Intensiva,2012,36:77-184.
[4] 中华医学会重症医学分会.中国严重脓毒症/脓毒症性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[5] Singer M,Deutschman CS,Seymour CW.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315:801-810.
[6] 邢豫宾,戴路明,赵芝焕,等.血清降钙素原和常用炎症指标结合SOFA评分对脓毒症早期诊断和预后价值的评价[J].中国危重病急救医学,2008,20(1):23-28.
[7] 高伟,王增智,刘双,等.APACHEⅡ、SOFA评分和血小板计数对高龄MODS患者预后的研究[J].北京医学,2007,29(8):479-480.
[8] 魏捷,孙胜男,吕菁君,等.降钙素原对免疫功能异常的脓毒症患者病情评估和预后判断[J].中华急诊医学杂志,2013,22(8):902-906.
[9] 黎伟.血清PCT在老年社区获得性细菌性肺炎的临床应用价值[J].中国微生态学杂志,2015,27(7):840-843.
[10] Choe EA,Shin TG,Jo IJ,et al.The prevalence and clinical significance of low procalcitonin levels among patients with severe sepsis or septic shock in the emergency department[J].Shock,2016,46:37-43.
[11] Gonsalves MD,Sakr Y.Early identification of sepsis[J].Curr Infect Dis Rep,2010,12:329-335.
[12] Beseoglu K,Etminan N,Hanggi D.The value of perfusion computed tomography(PCT)imaging after aneurysmal subarachnoid hemorrhage:a review of the current data[J].Acta Neurochir Suppl,2015,120:35-38.
[13] LEE H.Procalcitonin as a biomarker of infectious diseases[J].Korean J Intern Med,2013,28:285-291.
[14] Poddar B,Gurjar M,Singh S,et al.Procalcitonin kinetics as a prognostic marker in severe sepsis/septic shock[J].Indian J Crit Care Med,2015,19:140-146.
[15] Hegazy MA,Omar AS,Samir N,et al.Amalgamation of procalcitonin,C-reactive protein,and sequential organ failure scoring system in predicting sepsis survival[J].Anesth Essays Res,2014,8:296-301.
[16] 朱翔,许芳,武其文.降钙素原在脓毒血症患者早期诊断及预后评估中的意义[J].临床血液学杂志,2016,29(6):970-971.
[17] 刘慧琳,刘桂花.脓毒症患者降钙素原与APACHEⅡ评分的相关性探讨[J].中华急诊医学杂志,2012,21(4):371-374.
[18] 查君敬,黄利娟,方长太,等.脓毒症患者血清白细胞介素-6、降钙素原及C-反应蛋白与SOFA评分的相关性[J].实用医学杂志,2015,31(22):3738-3740.
[2] 吴钦良,嵇金陵,张小云.血清降钙素原动态检测对脓毒血症诊断和预后的应用价值分析[J].临床血液学杂志,2018,31(12):901-903.
[3] Suberviola B,Castellanos-Ortega A,González-Castro A,et al.Prognostic value of procalcitonin,C-reactive protein and leukocytes in septic shock[J].Med Intensiva,2012,36:77-184.
[4] 中华医学会重症医学分会.中国严重脓毒症/脓毒症性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[5] Singer M,Deutschman CS,Seymour CW.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315:801-810.
[6] 邢豫宾,戴路明,赵芝焕,等.血清降钙素原和常用炎症指标结合SOFA评分对脓毒症早期诊断和预后价值的评价[J].中国危重病急救医学,2008,20(1):23-28.
[7] 高伟,王增智,刘双,等.APACHEⅡ、SOFA评分和血小板计数对高龄MODS患者预后的研究[J].北京医学,2007,29(8):479-480.
[8] 魏捷,孙胜男,吕菁君,等.降钙素原对免疫功能异常的脓毒症患者病情评估和预后判断[J].中华急诊医学杂志,2013,22(8):902-906.
[9] 黎伟.血清PCT在老年社区获得性细菌性肺炎的临床应用价值[J].中国微生态学杂志,2015,27(7):840-843.
[10] Choe EA,Shin TG,Jo IJ,et al.The prevalence and clinical significance of low procalcitonin levels among patients with severe sepsis or septic shock in the emergency department[J].Shock,2016,46:37-43.
[11] Gonsalves MD,Sakr Y.Early identification of sepsis[J].Curr Infect Dis Rep,2010,12:329-335.
[12] Beseoglu K,Etminan N,Hanggi D.The value of perfusion computed tomography(PCT)imaging after aneurysmal subarachnoid hemorrhage:a review of the current data[J].Acta Neurochir Suppl,2015,120:35-38.
[13] LEE H.Procalcitonin as a biomarker of infectious diseases[J].Korean J Intern Med,2013,28:285-291.
[14] Poddar B,Gurjar M,Singh S,et al.Procalcitonin kinetics as a prognostic marker in severe sepsis/septic shock[J].Indian J Crit Care Med,2015,19:140-146.
[15] Hegazy MA,Omar AS,Samir N,et al.Amalgamation of procalcitonin,C-reactive protein,and sequential organ failure scoring system in predicting sepsis survival[J].Anesth Essays Res,2014,8:296-301.
[16] 朱翔,许芳,武其文.降钙素原在脓毒血症患者早期诊断及预后评估中的意义[J].临床血液学杂志,2016,29(6):970-971.
[17] 刘慧琳,刘桂花.脓毒症患者降钙素原与APACHEⅡ评分的相关性探讨[J].中华急诊医学杂志,2012,21(4):371-374.
[18] 查君敬,黄利娟,方长太,等.脓毒症患者血清白细胞介素-6、降钙素原及C-反应蛋白与SOFA评分的相关性[J].实用医学杂志,2015,31(22):3738-3740.