Chen Wei, Li Li-juan, Gu Xu-yun, Wang Suo-zhu, Zhao Lei
Department of Critical Care Medicine, Capital Medical University, Beijing, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Aug;24(8):470-3.
To investigate the predictor value of peripheral blood procalcitonin (PCT) levels in the evaluation of prognosis of patients with septic shock.
A prospective study was conducted. Eighty-four patients with septic shock in intensive care unit (ICU) of Beijing Shijitan Hospital Affiliated to Capital Medical University were enrolled from May, 2011 to January, 2012. Serum PCT levels were monitored, and the acute physiology and chronic health evaluation II (APACHEII) score, sequential organ failure assessment (SOFA) score were recorded at the 1st, 3rd, 5th, and 7th day after admission. According to the 28-day outcome after admission to ICU, the patients with septic shock were divided into the survivor group and non-survivor group, dynamic changes in serum PCT levels were compared between two groups and correlation analysis was carried out on serum PCT levels and the APACHEII score, SOFA score.
(1) There was no significant difference in serum PCT levels (μg/L) at the 1st and 3rd day between survivor group (n=38) and non-survivor group (n=46), but the serum PCT levels at the 5th and 7th day in non-survivor group were significantly higher than that in survivor group (5 days: 8.79±2.38 vs. 2.38±0.88, 7 days: 12.57±3.29 vs. 0.71±0.22, both P<0.05), and the drop of PCT concentrations were significant compared with survivor group (1.91±1.21 vs. 10.27±4.49, P<0.05). At the same time, positive statistical correlation was found between serum PCT levels and APACHEII score, SOFA score (5 days: R(APACHEII)=0.395, R(SOFA)=0.396; 7 days: R(APACHEII)=0.675, R(SOFA)=0.648, all P<0.01). (2) Receiver operator characteristic curve (ROC curve) of serum PCT levels on the 7th day could significantly predict the 28-day mortality, maximal area under the curve (AUC) of PCT was 0.886. When PCT was 0.965 μg/L, the sensitivity and specificity were appropriate. By multivariate factors logistic regression, serum PCT concentrations were not significantly correlated with 28-day mortality. (3) The median survival time (days) of patients with 7-day PCT <1.0 μg/L was far more than that of the patients with PCT>1.0 μg/L (28.0 vs. 14.1, P<0.05).
Dynamic monitoring of serum PCT levels can help to assessment the prognosis of septic shock and also in predicting the severity of the illness, but it may not be a significant independent prognostic marker for 28-day survival in the patients with septic shock.
探讨外周血降钙素原（PCT）水平对脓毒性休克患者预后评估的预测价值。
进行一项前瞻性研究。选取2011年5月至2012年1月首都医科大学附属北京世纪坛医院重症监护病房（ICU）的84例脓毒性休克患者。监测血清PCT水平，并在入院第1、3、5和7天记录急性生理与慢性健康状况评分系统II（APACHEII）评分、序贯器官衰竭评估（SOFA）评分。根据入住ICU后28天的结局，将脓毒性休克患者分为存活组和非存活组，比较两组血清PCT水平的动态变化，并对血清PCT水平与APACHEII评分、SOFA评分进行相关性分析。
（1）存活组（n = 38）和非存活组（n = 46）在第1天和第3天的血清PCT水平（μg/L）无显著差异，但非存活组在第5天和第7天的血清PCT水平显著高于存活组（第5天：8.79±2.38 vs. 2.38±0.88，第7天：12.57±3.29 vs. 0.71±0.22，均P<0.05），且与存活组相比，PCT浓度下降幅度显著（1.91±1.21 vs. 10.27±4.49，P<0.05）。同时，血清PCT水平与APACHEII评分、SOFA评分呈正相关（第5天：R(APACHEII)=0.395，R(SOFA)=0.396；第7天：R(APACHEII)=0.675，R(SOFA)=0.648，均P<0.01）。（2）第7天血清PCT水平的受试者工作特征曲线（ROC曲线）可显著预测28天死亡率，PCT的最大曲线下面积（AUC）为0.886。当PCT为0.965μg/L时，敏感度和特异度适宜。多因素逻辑回归分析显示，血清PCT浓度与28天死亡率无显著相关性。（3）7天PCT<1.0μg/L患者的中位生存时间（天）远长于PCT>1.0μg/L患者（28.0 vs. 14.1，P<0.05）。
动态监测血清PCT水平有助于评估脓毒性休克的预后及病情严重程度，但可能不是脓毒性休克患者28天生存的显著独立预后指标。
