PCT与SDI比值对重症细菌性肺炎患者短期预后的预测价值

Predictive value of PCT/SDI ratio for short-term prognosis of patients with severe bacterial pneumonia

摘要:

目的 探讨血清降钙素原(PCT)与肺泡灌洗液辛普森菌群多样性指数(SDI)比值对重症监护病房(ICU)内细菌性肺炎患者短期预后的预测价值。 方法 回顾性调查扬州大学附属医院ICU 2019年10月—2021年7月选择肺泡灌洗液宏基因组二代测序(mNGS)技术的56例细菌性肺炎患者病历资料，依据其入ICU 24 h内急性生理学与慢性健康状况评分Ⅱ(APACHE-Ⅱ)分为非危重症组21例和危重症组35例。以细菌性肺炎造成死亡为终点事件，记录28天转归，并将患者分为生存组38例和死亡组18例。对各组患者的SDI、PCT、C-反应蛋白(CRP)、PCT/SDI、CRP/SDI进行比较分析。 结果 与非危重症组比较，危重症组患者血清PCT/SDI、PCT水平均升高，且呼吸机辅助通气时间更长，28天病死率更高(均P＜0.05)；与存活组比较，死亡组患者SDI较低，PCT/SDI、PCT水平均较高(均P＜0.05)；SDI与呼吸机辅助通气时间呈负相关(r值为-0.655，P＜0.001)，PCT水平、PCT/SDI与呼吸机辅助通气时间呈正相关(r值分别为0.660、0.734，均P＜0.001)。受试者工作特征曲线(ROC曲线)显示，PCT/SDI预测患者28天死亡的ROC曲线下面积(AUC)为0.851，其次为PCT+SDI(0.845)、PCT(0.808)、SDI(0.785)、CRP/SDI(0.731)，PCT/SDI的最佳截断值为11.56时预判患者28天死亡的灵敏度为89.5%，特异度为66.7%。Cox回归分析显示，PCT/SDI值高(HR=1.562，95%CI：1.271~1.920，P=0.031)、PCT水平高(HR=1.106，95%CI：1.021~1.198，P=0.024)是ICU细菌性肺炎患者死亡的独立危险因素。 结论 PCT/SDI、PCT、PCT+SDI、SDI、CRP/SDI均可作为ICU细菌性肺炎患者短期预后的评估指标。与其他指标相比，PCT/SDI预测患者短期预后更有价值。

Abstract:

Objective To explore the predictive value of the ratio of serum procalcitonin (PCT) to Simpson's diversity index (SDI) in alveolar lavage fluid for the short-term prognosis of patients with bacterial pneumonia in intensive care unit (ICU). Methods Medical records of 56 patients with bacterial pneumonia who were performed alveolar lavage fluid metagenomic next-generation sequencing (mNGS) technology in ICU of the Affiliated Hospital of Yangzhou University from October 2019 to July 2021 were retrospectively investigated, according to the acute physiology and chronic health evaluation (APACHE-Ⅱ) scoring system within 24 hours after admission to ICU, patients were divided into non-critical group (n=21) and critical group (n=35). Taking death caused by bacterial pneumonia as the end event, 28-day prognosis was recorded, patients were divided into survival group (n=38) and death group (n=18). SDI, PCT, C-reactive protein (CRP), PCT/SDI and CRP/SDI of patients in each group were compared and analyzed. Results Compared with non-critical group, critical group had higher levels of PCT/SDI and PCT, longer duration of ventilator-assisted ventilation, and higher 28-day mortality (all P < 0.05); compared with survivor group, death group had lower SDI, as well as higher PCT/SDI and PCT (both P < 0.05); SDI was negatively correlated with duration of ventilator-assisted ventilation (r values were -0.655, P < 0.001). PCT, PCT/SDI were positively correlated with duration of ventilator-assisted ventilation time (r values were 0.660, 0.734, respectively, both P < 0.001). The receiver operating characteristic curve (ROC curve) shows that the area under the ROC curve (AUC) of PCT/SDI for predicting 28-day mortality of patients was 0.851, followed by PCT+SDI (0.845), PCT (0.808), SDI (0.785), and CRP/SDI (0.731), when optimal cut-off value of PCT/SDI was 11.56, sensitivity and specificity for predicting 28-day mortality of patients were 89.5% and 66.7% respectively. Cox regression analysis showed that high PCT/SDI value (HR=1.562, 95%CI: 1.271-1.920, P=0.031) and high PCT level (HR=1.106, 95%CI: 1.021-1.198, P=0.024) were independent risk factors for death of ICU patients with bacterial pneumonia. Conclusion PCT/SDI, PCT, PCT+SDI, SDI and CRP/SDI can all be used as short-term prognostic indicators for bacterial pneumonia in ICU patients. Compared with other indicators, PCT/SDI is more valuable in predicting the short-term prognosis of patients.