摘要
目的评估降钙素原(PCT)的动态监测在预测呼吸机相关肺炎(VAP)患者预后中的作用。方法前瞻性队列研究,以连续收治的确诊为VAP的患者为研究对象,随访至28d。动态监测VAP患者的PCT值并计算变化值(△PCT),比较上述指标在生存组与死亡组的差异,通过多因素回归模型寻找预测VAP死亡的独立危险因素。结果死亡组第1、4、7天的PCT值明显高于生存组(P<0.05),其预测VAP死亡的曲线下面积(AUC)值分别0.732,0.741,0.797;而PCT的动态变化值(△PCT)在两组患者之间差异无统计学意义(P>0.05);在多因素回归模型中,只有第7天的全身感染性相关器官功能衰竭评分(SOFA)评分[OR=6.381(95%CI:2.690～15.141)]和第4天的APACHEⅡ评分[OR=1.853(95%CI:(1.210～1.781)]是预测VAP患者死亡的独立危险因素。结论 PCT的动态监测不能作为评估VAP患者28d死亡的独立危险因素。对VAP患者预后的评估需要临床的综合指标来判断。
Objective To assess the value of procalcitonin（PCT） in predicting the outcome of ventilator-associated pneumonia（VAP） patient.Methods Prospective cohort study.Patients consecutively admitted and diagnosed with VAP were studied and followed until day 28.Dynamic serum PCT levels were measured and their alteration between different days（△PCT） were calculated in death and survival groups.These parameters had been investigated as independent variables in relation to 28-day death as dependent variable.Results The increase of PCT levels on day 1,4 and 7 were found in the death group（P〈0.05）and significantly predictive of death with area under curve（AUC） of 0.732,0.741 and 0.797,respectively.However,kinetics of PCT levels（△PCT） did not show a significant difference between the death and survival（P〈0.05）.Multivariate analysis revealed that only SOFA（day 7） [OR=6.381,（95%CI：2.690-15.141）] and APACHEⅡ（day 4）[OR=1.468（95%CI：1.210-1.781）] predicted death.Conclusion Neither PCT individual levels nor their kinetics during VAP course can predict patient outcome in 28 days.Comprehensive evaluation of patients with multiple methods may increase predictive accuracy in the future.
出处
《重庆医学》
CAS
CSCD
北大核心
2013年第3期266-268,共3页
Chongqing medicine
关键词
降钙素原
呼吸机相关肺炎
C反应蛋白质
procalcitonin
ventilator-associated pneumonia
C-reaction protein
