The clinicalvalue of procalcitoninin the condition and prognosis of patients with sepsis / 中华急诊医学杂志

ABSTRACT

Objective To explore the clinical value of procalcitonin (PCT)in the disease severity and prognosis of patients with sepsis,and the relationship between PCT and acute physiology and chronic health evaluation Ⅱscore (APACHEⅡscore).Methods Clinical data (including the value of PCT,the count of the white blood cell WBC and the percent of neutrophils percentage Neut%,APACHEⅡ score,et al,within 24 hours after admission)of 109 sepsis patients admitted to the emergency department (including the general ward and emergency intensive care unit EICU)and infections department of our hospital from January 1st 2013 to December 31st 2014 were retrospectively analyzed.The patients were divided into several groups according to the patients condition (the sepsis group,the severe sepsis group and the septic shock group),the clinical outcomes (the survival group and the dead group ),and multiple organ dysfunction syndrome MODS (the MODS group and the non-MODS group),comparing the differences of all markers in each group;to analyze the correlation between PCT and APACHEⅡ score;to assess the value of PCT,APACHE Ⅱ score and APACHE Ⅱ score +PCT for prognosis and multiple organ dysfunction syndrome of patients with sepsis;to have a understanding of the independent effect of PCT on the prognosis andthe factors of prognosis in patients with sepsis.Results The value of PCT,APACHEⅡ score in sepsis group was lower than the severe sepsis group and the septic shock group,also the severe sepsis was lower than the septic shock group,and each group was significantly different (P <0.05).Compared with the septic shock group,the count of WBC of sepsis group was significantly lower (P <0.05).Also the dead group compared with the survival group,the APACHEⅡ score was significantly increased (P <0.01),but the values of PCT,WBC,Neut% were not significantly different.The values of APACHEⅡ score,WBC, Neut%,PCT in the non-MDOS group were significantly lower than those in the MODS group (all P <0.05).The relationship between the values of PCT and APACHEⅡ score was significantly correlated (rs=0.403,P <0.01 ).Using the receiver operating characteristic curve (ROC ) for evaluating the prognosis,the area under curve (AUC)of PCT,APACHE Ⅱ score and the PCT +APACHE Ⅱ score respectively were 0.617,0.899,0.917,and the last two were significantly better (all P <0.01),also the cut-off,sensitivity and specificity of PCT,APACHE Ⅱ score were respectively (3.40 ng/mL, 88.24%,38.04%),(20 scores,94.12%,81.52%).As the same to evaluating MODS,the AUC of PCT,APACHEⅡ score and APACHE Ⅱ score +PCT respectively were 0.824,0.796,0.871,the assessed value between PCT and APACHEⅡ score,between PCT and APACHEⅡ score +PCT were not significantly different;also the cut-off,sensitivity and specificity of PCT,APACHEⅡ score respectively were (7.26 ng/mL,88.24%,63.79%), (17 scores,64.71%,87.93%).The COR and AOR of PCT for the prognosis were respectively 1.008,1.014,and gender and APACHE Ⅱ score were the two independent risk factors for the prognosis in patients with sepsis.Conclusions The value of PCT and APACHEⅡ score could evaluate the severity of illness in sepsis patients,and the three were positive correlations.APACHEⅡ score,APACHEⅡ score +PCT had a significantly higher prognostic value than PCT,and PCT could not be a independent marker.But for assessing the MODS in patients with sepsis,the assessed value of PCT,APACHEⅡ score,APACHEⅡ score +PCT were medium.Gender and APACHEⅡ score were the two independent risk factors for the prognosis in patients with sepsis.