降钙素原清除率对老年严重脓.PDFVIP

浙江医学浙江医年第年第3939 卷第卷第99 期期 降钙素原清除率对老年严重脓 毒症/ 脓毒性休克预后的预测 价值 颜默磊 蔡国龙 胡才宝 李莉 吕晓春 陈进 虞意华 严静 【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 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 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。 【关键词】 脓毒症 老年 降钙素原 预后 PCT clearance rate as an outcome predictor for elderly septic patients China 【Abstract 】 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 facto