摘要
目的探讨动态监测降钙素原(PCT)清除率对老年严重脓毒症/脓毒性休克患者预后的预测价值。方法采用回顾性研究方法分析入选的319例严重脓毒症/脓毒性休克老年患者的临床资料。根据入组第1、3、5、7天的PCT,分别计算第3、5、7天PCT清除率。根据28d是否死亡分成死亡组及生存组,分析两组患者PCT及PCT清除率的差别,应用ROC曲线分析评价包括不同时点PCT、PCT清除率及入组第1天的血乳酸、早期乳酸清除率等多项临床指标对老年严重脓毒症/脓毒性休克预后预测的准确性,应用logistic回归分析预后的独立危险因素。结果与死亡组相比,生存组第1、3、5、7天PCT水平较低而第3、5、7天PCT清除率较高且差异均有统计学意义(均P<0.05);单独应用第7天PCT清除率对预后的准确性较好,AUC为0.757;第7天PCT清除率是导致老年严重脓毒症/脓毒性休克患者28d死亡的独立危险因素之一。结论第7天PCT清除率是老年严重脓毒症/脓毒性休克患者28d死亡的独立的危险因素,对老年严重脓毒症/脓毒性休克患者预后具有一定的预测价值。
Objective To evaluate the prognosis value of procalcitonin(PCT) and PCT clearance rate in elderly patients with severe sepsis/septic shock. Methods The clinical data of 319 elderly patients with severe sepsis/septic shock were analyzed retrospectively. The PCT clearance rate on d3, d5 and d7 was calculated on the basis of serum PCT levels at d1, d3,d5 and d7. According to the survival at d28 patients were divided into fatal and survival groups and the difference in PCT level and PCT clearance rate between the two groups was analyzed. ROC curve was used to evaluate the prognostic value of PCT and PCT clearance rate in patients with severe sepsis/septic shock. The prognostic risk factors were assessed with logistic regression analysis. Results Compared with the fatal group, the PCT level was lower at d1, d3, d5 and d7, and the PCT clearance rate was higher on d3, d5 and d7 in the survival group. The area under the AUC curve of PCT clearance rate at d7 was 0.757, and it was an independent risk factor of death with 28 d in elderly patients with severe sepsis/septic shock.Conclusion PCT clearance rate at d7 may be used as a predictor for poorer prognosis in elderly patients with severe sepsis/septic shock.
出处
《浙江医学》
CAS
2017年第9期708-712,共5页
Zhejiang Medical Journal
基金
卫生行业科研专项资助项目(201202011)
浙江省自然科学基金青年基金项目(LQ14H150001)
关键词
脓毒症
老年
降钙素原
预后
Sepsis
The elderly
Procalcitonin
Prognosis
