解放军医学院学报2017，Vol.38Issue(6)：519-523,5.DOI:10.3969/j.issn.2095-5227.2017.06.008
血清PCT、IL-18及APACHEⅡ评分对老年重症肺炎患者预后的评估价值
Serum PCT, IL-18 and APACHEⅡscore in prognostic prediction to severe pneumonia in elderly patients
陈凯立 1张汉洪 1邢金莉 1霍娟勇 2林文科3
作者信息
- 1. 海南省中医院 急诊科,海南海口 570203
- 2. 海南省中医院 重症医学科,海南海口 570203
- 3. 海南省第三人民医院 检验科,海南三亚 572000
- 折叠
摘要
Abstract
Objective To explore the value of serum procalcitonin (PCT), interleukin-18 (IL-18) and acute physiology and chronic health evaluation (APACHE) score in prognostic prediction to severe pneumonia in elderly patients. Methods Totally 286 elderly patients with severe pneumonia were selected from January 2013 to October 2016 in Hainan Provincial Hospital of traditional Chinese medicine, and divided into survival group (n=203 cases) and death group (n=83 cases) according to the 28-day survival. The dynamic changes of serum PCT, IL-18 levels and APACHE Ⅱ score were compared between the two groups at D1, D4 and D7. Multivariate Logistic regression analysis was used to analyze the risk factors of prognosis in elderly patients with severe pneumonia, and the ROC curve was used to evaluate the predictive value of PCT, IL-18 and APACHE Ⅱ score in the prognosis of elderly patients with severe pneumonia. Correlation analysis of PCT with IL-18 and APACHE was performed by Pearson correlation analysis. Results The serum PCT [(4.69±1.75) ng/ml vs (0.41±0.15) ng/ml, IL-18 (85.16±20.17) ng/ml vs (68.23±18.56) ng/ml and APACHE Ⅱ score (27.84±4.63) ng/ml vs (23.87±4.16) ng/ml] in the death group were significantly higher than those in the survival group (P < 0.05, respectively). Logistic regression analysis showed that mechanical ventilation [OR(95% CI): 6.018 (2.175-11.974)], PCT [OR(95% CI): 2.427 (1.359-5.826)], IL-18[OR(95% CI): 1.805 (1.106-4.283)] and APACHE score [OR(95%CI): 4.482 (1.892 -8.747)] were independent risk factors of death in elderly patients with severe pneumonia (P < 0.05, respectively). ROC curve showed that combination of PCT,IL-18 and APACHE Ⅱ score was most sensitive (89.4%) and specific (81.6%) for predicting mortality in elderly patients with severe pneumonia. Correlation analysis showed that the serum PCT level in death group was positively correlated with IL-18 and APACHE score (r=0.473, P=0.025; r=0.681, P < 0.001). Conclusion Serum PCT, IL-18 and APACHE Ⅱ score are independent risk factors for mortality in elderly patients with severe pneumonia, and combination of three indexes is of good value in predicting the prognosis.关键词
老年/重症肺炎/降钙素原/白细胞介素-18/急性生理学与慢性健康状况评分系统Ⅱ评分Key words
senile/severe pneumonia/procalcitonin/interleukin-18/acute physiology and chronic health evaluation Ⅱ score分类
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陈凯立,张汉洪,邢金莉,霍娟勇,林文科..血清PCT、IL-18及APACHEⅡ评分对老年重症肺炎患者预后的评估价值[J].解放军医学院学报,2017,38(6):519-523,5.
