降钙素原和血小板对尿脓毒症患者的预后价值。
Prognostic values of procalcitonin and platelet in the patient with urosepsis.
机构信息
Department of Clinical Laboratory Center, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China.
Department of Respiratory and Critical Care Medicine, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China.
出版信息
Medicine (Baltimore). 2021 Jul 9;100(27):e26555. doi: 10.1097/MD.0000000000026555.
BACKGROUND
The patient suffering from urinary sepsis is often accompanied by elevated serum procalcitonin (PCT) levels and a decline in the average platelet count (PLT), which could result in a poor prognosis. This study aimed to evaluate the value of PCT and PLT in determining the severity of urinary sepsis.
METHODS
A total of 120 urosepsis patients enrolled were divided into a survival group and a death group, respectively, according to their status within 14 days after admission. Changes in PCT and PLT levels between the 2 groups were compared at different time points. A receiver operating characteristic (ROC) curve was eventually obtained to predict the prognostic value of PCT and PLT.
RESULTS
The PCT levels in the survival group declined gradually after admission, and the PLT decreased at first but increased rapidly in subsequence. The PCT level in the death group, however, declined in a flat-slope trend or was hardly noticeable together with the number of PLT reduced significantly. In particular, it is on the 3rd day that PCT tended to positively correlate with acute physiological and chronic health score II (APACHE II) score (r = 0.730, P < .05), but negatively with PLT (r = 0.472, P < .05). The APACHE II score and PLT (r = 0.612, P < .05) were also negatively correlated with each other. As indicated by the ROC curve, the PCT level on the 3rd day after admission was of great value for the clinical mortality prognosis, and the area under the curve was 0.858. Moreover, PLT also has a high predictive value for prognosis. Area under the curve is 0.951. When the PLT was more than 51 × 109 /L, the sensitivity was up to 90%, and the specificity was 90%.
CONCLUSION
PLT and PCT levels are closely related to the APACHE II score, which could indicate the severity of urosepsis in patients. The contribution of this study was to confirm that dynamic monitoring of the changes in PCT and PLT helps determine the prognosis of urosepsis patients.
背景
患有尿脓毒症的患者常伴有血清降钙素原（PCT）水平升高和平均血小板计数（PLT）下降，这可能导致预后不良。本研究旨在评估 PCT 和 PLT 在确定尿脓毒症严重程度方面的价值。
方法
共纳入 120 例尿脓毒症患者，根据入院后 14 天内的生存状态分为生存组和死亡组。比较两组不同时间点 PCT 和 PLT 水平的变化。最终获得受试者工作特征（ROC）曲线以预测 PCT 和 PLT 的预后价值。
结果
生存组患者入院后 PCT 水平逐渐下降，PLT 先下降后迅速升高。死亡组 PCT 水平呈平缓下降趋势或几乎不变，PLT 明显减少。特别是第 3 天，PCT 与急性生理和慢性健康状况评分 II（APACHE II）评分呈正相关（r = 0.730，P < .05），与 PLT 呈负相关（r = 0.472，P < .05）。APACHE II 评分与 PLT 也呈负相关（r = 0.612，P < .05）。ROC 曲线表明，入院后第 3 天 PCT 水平对临床死亡率预后具有重要价值，曲线下面积为 0.858。此外，PLT 对预后也有较高的预测价值。曲线下面积为 0.951。当 PLT 大于 51×109/L 时，灵敏度高达 90%，特异性为 90%。
结论
PLT 和 PCT 水平与 APACHE II 评分密切相关，可提示患者尿脓毒症的严重程度。本研究的贡献在于证实动态监测 PCT 和 PLT 的变化有助于判断尿脓毒症患者的预后。
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