摘要
目的 探讨尿素/白蛋白(UAR)、社区获得性肺炎评分量表(CURB-65)评分联合急诊感染三项[超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)]预测重症肺炎患者预后不良的价值.方法 选取2019 年8 月—2022 年8 月急诊科收治的重症肺炎131 例,根据随访30d预后情况将其分为预后良好组(34 例)与预后不良组(97 例).比较2 组一般资料及入院时和入院 1、3、7d时UAR、CURB-65 评分、hs-CRP、PCT、IL-6,分析上述指标单独及联合预测重症肺炎预后不良的价值.结果 预后不良组年龄及合并糖尿病、冠心病、慢性阻塞性肺疾病所占比例高于预后良好组,氧合指数低于预后良好组(P<0.05,P<0.01).入院时和入院 1、3、7d 时,预后不良组 UAR、CURB-65评分和hs-CRP、PCT、IL-6 高于预后良好组(P<0.05,P<0.01).入院时和入院1、3、7d时,预后良好组和预后不良组UAR、CURB-65 评分和hs-CRP、PCT、IL-6 呈先升高后下降趋势.Pearson相关性分析显示,入院时和入院1、3、7d时重症肺炎患者UAR、CURB-65 评分与hs-CRP、PCT、IL-6 均呈正相关(P<0.01).在校正其他因素前后,入院时UAR、CURB-65 评分和hs-CRP、PCT、IL-6 均与重症肺炎患者预后不良独立相关(P<0.01).受试者工作特征曲线分析结果显示,入院时UAR、CURB-65 评分和hs-CRP、PCT、IL-6 联合预测重症肺炎预后不良的曲线下面积为 0.928,大于单独预测的 0.748、0.712、0.772、0.767 和 0.746(P<0.05,P<0.01).结论 UAR、CURB-65 评分和hs-CRP、PCT、IL-6 联合预测重症肺炎患者预后不良的价值较高.
Abstract
Objective To investigate the value of urea nitrogen/albumin ratio(UAR)and confusion,urea nitrogen,respiratory rate,blood pressure and age≥65 years(CURB-65)scoring system for community acquired pneumonia(CAP)combined with three items of emergency infection[hypersensitive C-reactive protein(hs-CRP),procalcitonin(PCT)and in-terleukin-6(IL-6)]in predicting poor prognosis in patients with severe pneumonia.Methods A total of 131 patients with severe pneumonia admitted to the Emergency Department of our hospital from August 2019 to August 2022 were selected,and divided into good prognosis group(n =34)and poor prognosis group(n =97)based on 30-day follow-up.General data and the levels of UAR,CURB-65 scores,hs-CRP,PCT and IL-6 at admission and at 1 d,3 d and 7 d after admission were com-pared between the two groups.The value of the above indexes alone and in combination in predicting the poor prognosis of se-vere pneumonia was analyzed.Results The proportions of age,comorbid diabetes mellitus,coronary artery disease,and chronic obstructive pulmonary disease(COPD)was higher in the poor prognosis group than in the good prognosis group,while the oxygenation index was lower than that in the good prognosis group(P<0.05,P<0.01).The levels of UAR,CURB-65 score,hs-CRP,PCT and IL-6 in the poor prognosis group were higher than those in the good prognosis group at admission,and at 1 d,3 d and 7 d after admission(P<0.05,P<0.01).The levels of UAR,CURB-65 score,hs-CRP,PCT and IL-6 were firstly increased and then decreased at admission,and at 1 d,3 d and 7 d after admission in both groups.Pearson corre-lation analysis showed that UAR and CURB-65 scores were positively correlated with hs-CRP,PCT and IL-6 levels in patients with severe pneumonia at admission,and at 1 d,3 d and 7 d after admission(P<0.01).Before and after adjusting for other factors,UAR,CURB-65 score,hs-CRP,PCT and IL-6 were independently correlated with poor prognosis in patients with se-vere pneumonia at admission(P<0.01).Receiver operating characteristic(ROC)curve showed that the area under the ROC curve(AUC)of UAR,and CURB-65 score,combined with hs-CRP,PCT and IL-6,for predicting poor prognosis at admis-sion was 0.928,which was greater than that predicted by each indicator alone[0.748,0.712,0.772,0.767,and 0.746,respectively](P<0.05,P<0.01).Conclusion Combined detection of UAR,CURB-65 score,hs-CRP,PCT and IL-6 is of high value in predicting poor prognosis in patients with severe pneumonia.
基金项目
河北省医学科学研究课题(2023)(20231403)
维普
万方数据