Huang Wei-ping, Huang Cheng, Wen Miao-yun, Jiang Wen-qiang, Zeng Hong-ke
Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China. Corresponding author: Zeng Hong-ke, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013 Aug;25(8):467-70. doi: 10.3760/cma.j.issn.2095-4352.2013.08.005.
To investigate procalcitonin (PCT) change pattern in patients with septic shock and its relationship with prognosis.
Sixty-three septic shock patients were enrolled, and levels of PCT, C-reactive protein (CRP) as well as white blood cell (WBC) on 1st, 3rd, 5th,7th day after admission to intensive care unit (ICU) were checked. Patients were divided into survival group and death group according to 28-day survival result. Differences in parameters between two groups were compared. The change regulation of parameters along with in-hospital period and its relationship with prognosis were analyzed by multilevel linear model.
There were 41 patients in survival group and 22 patients in death group. PCT and CRP level decreased in survival group with time dependency pattern, while death group increased. The PCT at 3, 5, 7 days after admission to ICU in death group were significantly higher than those in survivors (3 days: 8.7±3.7 μg/L vs. 5.6±1.7 μg/L, 5 days: 10.3±1.3 μg/L vs. 4.8±2.3 μg/L, 7 days: 12.7±2.3 μg/L vs. 0.8±0.3 μg/L, P<0.05 or P<0.01), and CRP at 5 days and 7 days was significantly higher than those in survival group (5 days: 447±63 mg/L vs. 355±91 mg/L, 7 days: 439±45 mg/L vs. 364±63 mg/L, both P<0.05). Two groups of WBC did not change significantly, and there were no statistical significance difference at each time point between the two groups. What's more, the effect analysis results showed that there were significant changes in PCT as ICU day prolonged (F=10.91, P= 0.00), and there was a significant difference between the survivor and the dead (F=7.58, P=0.00), while CRP changed only with ICU stays (F=4.17, P=0.03).
Compared with CRP and WBC, PCT had higher sensitivity in predicting prognosis, sustainable elevation of PCT level indicates poor prognosis, serum PCT can be used as one of indexes predicting prognosis of septic shock.
探讨脓毒性休克患者降钙素原（PCT）变化规律及其与预后的关系。
纳入63例脓毒性休克患者，检测其入住重症监护病房（ICU）后第1、3、5、7天的PCT、C反应蛋白（CRP）及白细胞（WBC）水平。根据28天生存结果将患者分为生存组和死亡组，比较两组参数差异。采用多水平线性模型分析参数随住院时间的变化规律及其与预后的关系。
生存组41例，死亡组22例。生存组PCT和CRP水平呈时间依赖性下降，而死亡组升高。死亡组入住ICU后第3、5、7天的PCT显著高于生存者（第3天：8.7±3.7μg/L对5.6±1.7μg/L，第5天：10.3±1.3μg/L对4.8±2.3μg/L，第7天：12.7±2.3μg/L对0.8±0.3μg/L，P<0.05或P<0.01），第5天和第7天的CRP显著高于生存组（第5天：447±63mg/L对355±91mg/L，第7天：439±45mg/L对364±63mg/L，均P<0.05）。两组WBC无明显变化，两组各时间点比较差异无统计学意义。此外，效应分析结果显示，随着ICU住院天数延长，PCT有显著变化（F=10.91，P=0.00），生存者与死亡者之间有显著差异（F=7.58，P=0.00），而CRP仅随ICU住院时间变化（F=4.17，P=0.03）。
与CRP和WBC相比，PCT对预后预测具有更高的敏感性，PCT水平持续升高提示预后不良，血清PCT可作为预测脓毒性休克预后的指标之一。
