降钙素原联合SOFA评分对老年脓毒症患者预后的评估价值

目的:探讨降钙素原(procalcitonin,PCT)联合SOFA评分(sequential organ failure assessment,SOFA)对老年脓毒症患者预后的评估价值。方法:选择首都医科大学宣武医院急诊抢救室收治的105例老年脓毒症患者,入院后给予血常规、血清PCT水平、血气分析及生化全项等检查,并进行急性生理及慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ)和SOFA评分。根据预后将患者分成死亡组27例和存活组78例,比较两组组患者血清PCT水平、白细胞(WBC)、SOFA评分和APACHEⅡ评分,同时比较和分析APACHEⅡ评分、血清PCT水平、SOFA评分、PCT和SOFA评分联合预测患者死亡的受试者工作特征曲线(Receiver operating characteristic curve,ROC)下面积。结果:死亡组患者血清PCT水平、SOFA评分和APACHEⅡ评分均明显高于存活组(P0.05),两组WBC比较无统计学差异(P=0.132);PCT预测患者死亡的ROC曲线下面积为0.694(P=0.001),SOFA预测患者死亡的ROC曲线下面积为0.660(P=0.012),APACHE II评分预测患者死亡的ROC曲线下面积为0.852(P=0.001),大于PCT和SOFA评分(P0.05),PCT和SOFA评分联合预测患者死亡的ROC曲线下面积0.761(P=0.001),与APACHE II评分比较无统计学差异(P=0.139)。结论:血清PCT水平联合SOFA评分预测老年脓毒症患者预后的临床价值与APACHE II评分相当,均明显优于血清PCT水平和SOFA评分单项检测。

Prognostic Evaluation Value of Procalcitonin Combined with Sequential Organ Failure Assessment for the Elderly Patients with Sepsis

ABSTRACT Objective: To evaluate the prognostic value of procalcitonin (PCT) combined with sequential organ failure assessment (SOFA) score for the elderly patients with sepsis. Methods: 105 cases of elderly patients with sepsis admitted in the emergency resuscitation room in the Xuanwu Hospital of Capital Medical University were selected. After admission, the blood routine, serum PCT level, blood gas analysis and biochemical examination were given, the acute physiology and chronic health evaluation (APACHE II) and SOFA score were carried out. According to the prognosis, the patients were divided into 27 cases of death group and 78 cases of survival group, the serum PCT level, white blood cell (WBC), SOFA score and APACHE II score were compared between two groups. The area under receiver operating characteristic curve(ROC) of APACHE II score, serum PCT level, SOFA score, PCT and SOFA score were compared to predict the patients'' death. Results: The serum PCT level, SOFA score and APACHE II scores in the death group were higher than those in the survival group (P<0.05), and WBC showed no significant difference between two groups(P=0.132). The area under ROC curve (AUC) to predict patients'' death of serum PCT level was 0.694(P=0.001), which was 0.660(P=0.012) of SOFA score 0.852 of APACHE II score (P=0.001), and 0.761of PCT combined with SOFA score (P=0.001). There was no statistical difference in the AUC between APACHE II scores and PCT combined with SOFA score(P=0.139). Conclusion: The clinical value of serum PCT level combined with SOFA score in predicting the prognosis of elderly patients with sepsis was equivalent to that of APACHE II score, which was obviously superior to the serum PCT level or SOFA score alone.