血清降钙素原联合红细胞分布宽度检测在老年感染性休克患者预后中的应用价值
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摘要
目的分析血清降钙素原(PCT)联合红细胞分布宽度(RDW)检测在老年感染性休克患者预后中的价值。方法回顾性分析2016年5月至2018年5月我院收治的126例老年感染性休克患者的临床资料,以入院后30 d的转归情况将患者分为死亡组(37例)、好转组(59例)和迁延组(30例),比较三组患者治疗前及治疗后1、3、5、7 d的PCT水平及RDW,并采用ROC曲线分析PCT联合RDW对老年感染性休克患者预后的预测意义。结果治疗后3、5、7 d,好转组和迁延组PCT水平均显著降低,死亡组PCT水平显著升高,且好转组和迁延组低于死亡组,好转组PCT水平显著低于迁延组,差异具有统计学意义(P<0.05)。治疗后5、7 d,好转组RDW显著降低,死亡组RDW显著升高,且好转组显著低于死亡组,差异具有统计学意义(P<0.05);治疗后7 d,迁延组RDW显著升高,且显著低于死亡组,显著高于好转组,差异具有统计学意义(P<0.05)。PCT联合RDW对老年感染性休克患者病死率预测的AUC、灵敏度及特异度均显著优于两项单独检测(P<0.05)。结论 PCT联合RDW连续监测对于老年感染性休克患者的病情变化和转归预测有一定的参考意义,可以用于指导临床方案的设计,降低患者的死亡率,值得在临床上进一步推广应用。
Objective To analyze the value of serum procalcitonin(PCT) combined with red blood cell distribution width(RDW) on prognosis of elderly patients with septic shock. Methods The clinical data of 126 elderly patients with septic shock admitted in our hospital from May 2016 to May 2018 were retrospectively analyzed. The patients were divided into death group(37 cases), improvement group(59 cases) and deferment group(30 cases) according to the prognosis of 30 days after admission. The levels of PCT and RDW in the three groups before treatment and at 1, 3, 5, 7 days after treatment were compared. ROC curve was used to analyze the prognostic significance of PCT combined with RDW in elderly patients with septic shock. Results At 3, 5, 7 days after treatment, the PCT level in the improvement group and the deferment group decreased significantly, that in the death group increased significantly, and that in the improvement group and the deferment group were lower than those in the death group, and that in the improvement group was significantly lower than the deferment group, the differences were statistically significant(P<0.05). At 5, 7 days after treatment, RDW in the improvement group significantly decreased and in the death group significantly increased, and that in the improvement group was lower than the death group, and the difference was statistically significant(P<0.05). At 7 days after treatment,the RDW in the deferment group significantly increased, and that in the deferment group was lower than the death group and higher than the improvement group, and the differences were statistically significant(P<0.05). The AUC, sensitivity and specificity of PCT combined with RDW in predicting mortality of elderly septic shock patients were significantly better than those of the two tests alone(P <0.05). Conclusion Continuous monitoring of PCT combined with RDW has a certain reference significance for the change and prognosis prediction of elderly septic shock patients. It can be used to guide the design of clinical programs and reduce the mortality rate of patients. The PCT combined with RDW is worthy of further popularization and application in clinic.
Objective To analyze the value of serum procalcitonin(PCT) combined with red blood cell distribution width(RDW) on prognosis of elderly patients with septic shock. Methods The clinical data of 126 elderly patients with septic shock admitted in our hospital from May 2016 to May 2018 were retrospectively analyzed. The patients were divided into death group(37 cases), improvement group(59 cases) and deferment group(30 cases) according to the prognosis of 30 days after admission. The levels of PCT and RDW in the three groups before treatment and at 1, 3, 5, 7 days after treatment were compared. ROC curve was used to analyze the prognostic significance of PCT combined with RDW in elderly patients with septic shock. Results At 3, 5, 7 days after treatment, the PCT level in the improvement group and the deferment group decreased significantly, that in the death group increased significantly, and that in the improvement group and the deferment group were lower than those in the death group, and that in the improvement group was significantly lower than the deferment group, the differences were statistically significant(P<0.05). At 5, 7 days after treatment, RDW in the improvement group significantly decreased and in the death group significantly increased, and that in the improvement group was lower than the death group, and the difference was statistically significant(P<0.05). At 7 days after treatment,the RDW in the deferment group significantly increased, and that in the deferment group was lower than the death group and higher than the improvement group, and the differences were statistically significant(P<0.05). The AUC, sensitivity and specificity of PCT combined with RDW in predicting mortality of elderly septic shock patients were significantly better than those of the two tests alone(P <0.05). Conclusion Continuous monitoring of PCT combined with RDW has a certain reference significance for the change and prognosis prediction of elderly septic shock patients. It can be used to guide the design of clinical programs and reduce the mortality rate of patients. The PCT combined with RDW is worthy of further popularization and application in clinic.
引文
[1]商娜,周荣斌.脓毒症流行病学研究[J].中国急救医学,2013,3(1):8-12.
[2] LEVINSON AT, C ASSERLY BP,LEVY MM.Reducing mortality in severe sepsis and septic shock[J].Semin Respir Crit Care Med,2011,32(2):195-205.
[3] ASFAR P,SCHORTGEN F,BOISRAM魪HELMS J,et al.Hyperoxia and hypertonic saline in patients with septic shock(HYPERS2S):a two-by-two factorial, multicentre, randomised, clinical trial[J].Lancet Respir Med,2017,5(3):180-190.
[4] RHODES A,EVANS LE,ALHAZZANI W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock[J].Crit Care Med,2017,43(3):304-377.
[5] MORELLI A,SINGER M,RANIERI V,et al.Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock:a prospective observational study[J].Intensive Care Med,2016,42(10):1528-1534.
[6] NG PY,SIN WC,NG KY,et al.Speckle tracking echocardiography in patients with septic shock:a case control study(SPECKSS)[J].Crit Care,2016,20(1):1-8.
[7] BUSANI S,SERAFINI G,MANTOVANI E,et al.Mortality in Patients with septic shock by multidrug resistant bacteria[J].J Intensive Care Med,2017,34(1):48-54.
[8] VENKATARAMANI A,ZABANEH RI,SPECH TJ,et al.Septic shock in an elderly patient:unusual presentation of echovirus infection[J].South Med J,1993,86(10):1166-1167.
[9]陈子晞,许国根,王弋,等.红细胞分布宽度对感染性休克患者预后的预测价值[J].中华全科医学,2014,12(2):201-203.
[10] ALA-KOKKO TI,MUTT SJ,NISULA S,et al.Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock:observational FINNAKI cohort study[J].Annals of Medicine,2016,48(1-2):67-75.
[11] PIERCE CN,LARSON DF.Inflammatory eytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device[J].Perfusion,2005,20(2):83-90.
[12] CLARKE K,SAGUNARTHY R,KANSAL S.RDW as an additional marker in inflammatory bowel disease/undifferentiated colitis[J].Dig Dis Sci,2008,53(9):2521-2523.
[13] SADAKA F,O'BRIENJ,PRAKASH S.Red Cell Distribution width and outcome in patients with septic shock[J].J Intensive Care Med,2012,27(5):307-313.
[14]李帅,秦永明.降钙素原定量测定在感染性休克患者病情评估中的价值[J].吉林医学,2016,37(8):2040.
[15] M譈LLER B,BECKER KL,SCH魧CHINGER H,et al.Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit[J].Crit Care Med,2000,28(4):977-983.
[16]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.
[17]刘杰.血清降钙素原对感染性休克病情程度及疗效评估的价值[J].世界最新医学信息文摘,2016,16(75):10-11.
[2] LEVINSON AT, C ASSERLY BP,LEVY MM.Reducing mortality in severe sepsis and septic shock[J].Semin Respir Crit Care Med,2011,32(2):195-205.
[3] ASFAR P,SCHORTGEN F,BOISRAM魪HELMS J,et al.Hyperoxia and hypertonic saline in patients with septic shock(HYPERS2S):a two-by-two factorial, multicentre, randomised, clinical trial[J].Lancet Respir Med,2017,5(3):180-190.
[4] RHODES A,EVANS LE,ALHAZZANI W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock[J].Crit Care Med,2017,43(3):304-377.
[5] MORELLI A,SINGER M,RANIERI V,et al.Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock:a prospective observational study[J].Intensive Care Med,2016,42(10):1528-1534.
[6] NG PY,SIN WC,NG KY,et al.Speckle tracking echocardiography in patients with septic shock:a case control study(SPECKSS)[J].Crit Care,2016,20(1):1-8.
[7] BUSANI S,SERAFINI G,MANTOVANI E,et al.Mortality in Patients with septic shock by multidrug resistant bacteria[J].J Intensive Care Med,2017,34(1):48-54.
[8] VENKATARAMANI A,ZABANEH RI,SPECH TJ,et al.Septic shock in an elderly patient:unusual presentation of echovirus infection[J].South Med J,1993,86(10):1166-1167.
[9]陈子晞,许国根,王弋,等.红细胞分布宽度对感染性休克患者预后的预测价值[J].中华全科医学,2014,12(2):201-203.
[10] ALA-KOKKO TI,MUTT SJ,NISULA S,et al.Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock:observational FINNAKI cohort study[J].Annals of Medicine,2016,48(1-2):67-75.
[11] PIERCE CN,LARSON DF.Inflammatory eytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device[J].Perfusion,2005,20(2):83-90.
[12] CLARKE K,SAGUNARTHY R,KANSAL S.RDW as an additional marker in inflammatory bowel disease/undifferentiated colitis[J].Dig Dis Sci,2008,53(9):2521-2523.
[13] SADAKA F,O'BRIENJ,PRAKASH S.Red Cell Distribution width and outcome in patients with septic shock[J].J Intensive Care Med,2012,27(5):307-313.
[14]李帅,秦永明.降钙素原定量测定在感染性休克患者病情评估中的价值[J].吉林医学,2016,37(8):2040.
[15] M譈LLER B,BECKER KL,SCH魧CHINGER H,et al.Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit[J].Crit Care Med,2000,28(4):977-983.
[16]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.
[17]刘杰.血清降钙素原对感染性休克病情程度及疗效评估的价值[J].世界最新医学信息文摘,2016,16(75):10-11.