APACHEⅡ评分和降钙素原对肺部感染预后的预测作用.docVIP

APACHEⅡ评分和降钙素原对肺部感染预后的预测作用 梅春霞，刘 娟，徐 智，戢福云，吴国明 (400037重庆,第三军医大学新桥医院全军呼吸内科研究所，全军呼吸病研究重点实验室) [摘要] 目的 探讨APACHEⅡ评分和降钙素原对重症监护室肺部感染患者预后的预测价值。方法 收集2012年3月到2013年5月本院重症监护室肺部感染患者的临床资料，包括年龄、性别、APACHEⅡ评分、动脉血气、血沉、C-反应蛋白、乳酸、降钙素原、28 d结局、ARDS发生情况等, 绘制受试者工作特征曲线，比较APACHEⅡ评分和降钙素原对肺部感染患者28 d结局及并发ARDS的预测价值。结果 纳入患者78例，其中28 d内死亡19例，1周内发展为ARDS 33例。死亡组APACHEⅡ评分和降钙素原显著高于存活组，分别为[(23.3±7.5) vs (15.5±6.2),P0.001]和[18.6（1.5-25.0）ng/mL vs 1.0（0.3-25.0）ng/mL,P=0.044]，氧合指数低于存活组，为[(189.7±89.4) vs (238.0±91.7),P=0.048]。ARDS组APACHEⅡ评分和降钙素原显著高于非ARDS组，分别为[(19.9±8.3) vs (15.6±6.0),P=0.013]和[8.3（1.2-25.0）ng/mL vs 0.7(0.2-21.8)ng/mL,P=0.016]，氧合指数低于非ARDS组，为[（190.9±82.6 ）vs (252.1±92.4），P=0.003]。APACHEⅡ评分和降钙素原对28 d结局有一定预测作用，APACHEⅡ评分的预测作用大于降钙素原（AUROC：0.797 vs 0.652，P=0.057）。APACHEⅡ评分和降钙素原对并发ARDS也有一定预测作用，两者预测作用相当（AUROC:0.651 vs 0.657，P=0.929）。APACHEⅡ评分和降钙素原联合后对28 d结局及并发ARDS的预测作用较两者单独的预测作用无显著提高。结论 APACHEⅡ评分和降钙素原可以作为肺部感染预后的预测指标，有助于临床早期甄别预后差及具有ARDS高危倾向的患者。 [关键词] APACHEⅡ评分；降钙素原；肺部感染 [中图法分类号] [文献标志码] A [优先出版] /kcms/detail/51.1095.R1113.007.html(2014-02-19) The predictive value of APACHE II score and procalcitonin on the prognosis of patients with pulmonary infection Mei Chunxia, Liu Juan, Xu Zhi, Ji Fuyun, Wu Guoming（Institute of Human Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China） [Abstract] Objective To investigate whether acute physiology and chronic health evaluation II (APACHE II) score and plasma procalcitonin are valuable predictors on the prognosis in patients with pulmonary infection. Methods Patients (n = 78) with pulmonary infection in ICU from March 2012 to May 2013 were recruited from Xinqiao Hospital. The data including age, gender, APACHE II score, blood gas analysis, erythrocyte sedimentation, C-reactive protein, lactic acid, procalcitonin, mortality within 28 d, occurrence of ARDS, and so on were collected and analyzed using the receiver operating characteristic curve. Results