C-反应蛋白对成人社区获得性肺炎患者发展为脓毒症的风险预测价值
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摘要
目的分析C-反应蛋白(CRP)对成人社区获得性肺炎(CAP)患者发展为脓毒症的风险预测价值。方法回顾性分析2015年1月—2018年1月于中国医科大学附属盛京医院呼吸内科住院的成人CAP患者235例的临床资料,根据肺炎严重指数(PSI)将患者分层为PSⅡ～Ⅲ级和PSIⅣ～Ⅴ级,再分别分为非脓毒症组和脓毒症组,分级分组比较CRP水平及不同分级患者中不同CRP水平时脓毒症的发生率。采用ROC曲线确定CRP预测脓毒症的风险价值。结果 (1)在PSI分级Ⅰ～Ⅲ级和Ⅳ～Ⅴ级的患者中,脓毒症组CRP水平均比非脓毒症组高(U=785.000、351.000,P均<0. 01)。(2)在PSIⅠ～Ⅲ级和Ⅳ～Ⅴ级的患者中,CRP≥87 mg/L的患者脓毒症发生率均明显高于CRP <87 mg/L的患者(χ~2=23.328、11.792,P均<0. 01)。(3) CRP预测CAP患者发展为脓毒症的ROC曲线下面积为0. 84,最佳临界值为87 mg/L,灵敏度为78. 0%,特异度为74. 0%,阳性预测值为64. 0%,阴性预测值为85.0%,约登指数为0.52。结论 CAP患者CRP水平≥87 mg/L时脓毒症发生风险更高,将CRP≥87 mg/L作为高危因素联合PSI评分可以更好的预测CAP患者发展为脓毒症的风险。
Objective To analyze the predictive value of C reactive protein(CRP) in the development of sepsis in adult patients with community-acquired pneumonia(CAP). Methods The clinical data of 235 adult CAP patients hospitalized in the Department of Respiratory Medicine, Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2018 were retrospectively analyzed. According to the severity index of pneumonia(PSI), the patients were divided into PSI Ⅰ-Ⅲ and PSI IV-V classes. They were further divided into non-sepsis group and sepsis group. The incidence of sepsis was compared between different CRP levels and different GRP levels in different grading groups. The ROC curve was used to determine the risk value of CRP in predicting sepsis. Results(1) CRP levels in the sepsis group were higher than those in the non-sepsis group(U = 785.000,351.000. all P<0.01).(2) The incidence of sepsis in patients with CRP( ≥87 mg/L) was significantly higher than that in patients with CRP < 87 mg/L(χ~2= 23. 328,11.792, all P < 0.01).(3) The area under the ROC curve of CRP for predicting the development of CAP to sepsis was 0. 84, the optimal critical value was 87 mg/L, the sensitivity was 78.0%, the specificity was 74.0%, the positive predictive value was 64.0%, the negative predictive value was 85.0%, and the Yoden index was 0.52. Conclusion The risk of sepsis is higher in patients with CAP whose CRP level is higher than 87 mg/L. Taking CRP( ≥87 mg/L) as a high risk factor combined with PSI score can better predict the risk of developing sepsis in CAP patients.
Objective To analyze the predictive value of C reactive protein(CRP) in the development of sepsis in adult patients with community-acquired pneumonia(CAP). Methods The clinical data of 235 adult CAP patients hospitalized in the Department of Respiratory Medicine, Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2018 were retrospectively analyzed. According to the severity index of pneumonia(PSI), the patients were divided into PSI Ⅰ-Ⅲ and PSI IV-V classes. They were further divided into non-sepsis group and sepsis group. The incidence of sepsis was compared between different CRP levels and different GRP levels in different grading groups. The ROC curve was used to determine the risk value of CRP in predicting sepsis. Results(1) CRP levels in the sepsis group were higher than those in the non-sepsis group(U = 785.000,351.000. all P<0.01).(2) The incidence of sepsis in patients with CRP( ≥87 mg/L) was significantly higher than that in patients with CRP < 87 mg/L(χ~2= 23. 328,11.792, all P < 0.01).(3) The area under the ROC curve of CRP for predicting the development of CAP to sepsis was 0. 84, the optimal critical value was 87 mg/L, the sensitivity was 78.0%, the specificity was 74.0%, the positive predictive value was 64.0%, the negative predictive value was 85.0%, and the Yoden index was 0.52. Conclusion The risk of sepsis is higher in patients with CAP whose CRP level is higher than 87 mg/L. Taking CRP( ≥87 mg/L) as a high risk factor combined with PSI score can better predict the risk of developing sepsis in CAP patients.
引文
[1]GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013:a systematic analysis for the global burden of disease study 2013[J]. Lancet,2015,385(9963):117-171. DOI:10.1016/S0140-6736(14)61682-2.
[2]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):1-27. DOI:10.3760/cma.j.issn. 1001-0939.2016.03.000.
[3] Ranieri VM, Thompson BT, Barie PS,et al. Drotrecogin alfa(activated)in adults with septic shock[J]. N Engl J Med, 2012, 366(22):2055-2064. DOI:10.1056/NEJMoa1202290.
[4] Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia[J]. N Engl J Med, 1997,336(4):243-250. DOI:10.1056/NEJM199701233360402.
[5]Alan M, Grolimund E, Kutz A, et al. Clinical risk scores and blood biomarkers as predictors of long-term outcome in patients with community-acquired pneumonia:a 6-year prospective follow-up study[J]. Journal of Internal Medicine, 2015, 278(2):174-184. DOI:10. 1111/joim. 12341.
[6] Salazar J, Chavez M, Toledo A, et al. C-reactive protein clinical and epidemiological perspectives[J]. Cardiology Research&Practice, 2014, 2014:605810. DOI:10.1155/2014/605810.
[7] Farah R, Khamisyfarah R, makhoul N. Consecutive measures of CRP correlate with length of hospital stay in patients with communityacquired pneumonia.[J]. Israel Medical Association Journal Imaj,2018, 20(6):345-348.
[8]张征,吴霄迪.降钙素原和C反应蛋白评价脓毒血症的作用[J].中国城乡企业卫生,2018,33(9):17-19. DOI:10. 16286/j.1003-5052.2018.09.007.
[9]林振怀,孙武装,蒋晨成.社区获得性肺炎并发脓毒症患者外周血PCT、CRP及LAC水平的变化[J].现代中西医结合杂志,2016,25(10):1079-1081.
[10] Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J]. JAMA, 2016, 315(8):801-810. DOI:10.1001/jama.2016.0287.
[11] Del MG, Gangestad SW. Rethinking IL-6 and CRP:Why they aremore than inflammatory biomarkers, and why it matters.[J]. Brain Behavior&Immunity,2018,70(1):61-75. DOI:10. 1016/j. bbi.2018.02.013.
[12]徐艳玲,王彤,刘波,等.综合性医院2010-2016年痰培养病原菌分布及细菌耐药性分析[J].中国医药,2018,13(11):1733-1737.
[13]范丽萍,孔祥文,鲁姝,等.痰热清注射液联合抗菌药物治疗医院获得性肺炎效果及安全性的Meta分析[J].中国医药,2018,13(11):1642-1645.
[14]洪林杰,黄种杰,范洪涛,等.老年慢性阻塞性肺疾病患者合并呼吸机相关性肺炎的病原菌分布变迁及耐药性分析[J].疑难病杂志,2018,17(3):226-229. DOI:10. 369/j. issn. 1671-6450. 2018.03.003.
[15]Van der PT, van de Veerdonk FL, Scicluna BP, et al. The immunopathology of sepsis and potential therapeutic targets[J]. Nature reviews Immunology, 2017, 17(7):407-420. DOI:10. 1038/nri.2017.36.
[16] Starr ME,Saito M,Evers BM,et al. Age-associated Increase in cytokine production during systemic inflammation-II:The role of IL-1(3in age-dependent IL-6 upregulation in adipose tissue[J]. J Gerontol A Biol Sci Med Sci, 2015, 70(12):1508. DOI:10.1093/gerona/glu197.
[17]韩朋飞,赵嘉,党治国,等.氨溴索辅助治疗成人重症肺炎疗效及其对肺功能指标、炎性因子的影响[J].疑难病杂志,2018,17(1):10-13. DOI:10.3969/j.issn. 1671-6450.2018.01.003.
[18] Marti C,Garin N,Grosgurin 0,et al. Prediction of severe community-acquired pneumonia:a systematic review and meta-analysis[J]. Critical Care, 2012, 16(4):R141. DOI:10.1186/cc11447.
[19]顾鑫亮.C反应蛋白联合降钙素原诊断肺炎致脓毒症的价值研究[J].中国继续医学教育,2017,9(15):63-65.
[20]高宏光,唐时元,朱姝姮,等.血清降钙素原、C反应蛋白对转诊肺炎合并脓毒症患者预后的预测价值分析[J].华西医学,2013,28(9):1342-1344.
[21]贾建超,张文平,杨金坡,等.肺炎继发脓毒症患者血清降钙素原和C反应蛋白变化及预后因素分析[J].中华实用诊断与治疗杂志,2018,32(2):144-147. DOI:10. 13507/j. issn. 1674-3474.2018.02.011.
[2]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):1-27. DOI:10.3760/cma.j.issn. 1001-0939.2016.03.000.
[3] Ranieri VM, Thompson BT, Barie PS,et al. Drotrecogin alfa(activated)in adults with septic shock[J]. N Engl J Med, 2012, 366(22):2055-2064. DOI:10.1056/NEJMoa1202290.
[4] Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia[J]. N Engl J Med, 1997,336(4):243-250. DOI:10.1056/NEJM199701233360402.
[5]Alan M, Grolimund E, Kutz A, et al. Clinical risk scores and blood biomarkers as predictors of long-term outcome in patients with community-acquired pneumonia:a 6-year prospective follow-up study[J]. Journal of Internal Medicine, 2015, 278(2):174-184. DOI:10. 1111/joim. 12341.
[6] Salazar J, Chavez M, Toledo A, et al. C-reactive protein clinical and epidemiological perspectives[J]. Cardiology Research&Practice, 2014, 2014:605810. DOI:10.1155/2014/605810.
[7] Farah R, Khamisyfarah R, makhoul N. Consecutive measures of CRP correlate with length of hospital stay in patients with communityacquired pneumonia.[J]. Israel Medical Association Journal Imaj,2018, 20(6):345-348.
[8]张征,吴霄迪.降钙素原和C反应蛋白评价脓毒血症的作用[J].中国城乡企业卫生,2018,33(9):17-19. DOI:10. 16286/j.1003-5052.2018.09.007.
[9]林振怀,孙武装,蒋晨成.社区获得性肺炎并发脓毒症患者外周血PCT、CRP及LAC水平的变化[J].现代中西医结合杂志,2016,25(10):1079-1081.
[10] Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J]. JAMA, 2016, 315(8):801-810. DOI:10.1001/jama.2016.0287.
[11] Del MG, Gangestad SW. Rethinking IL-6 and CRP:Why they aremore than inflammatory biomarkers, and why it matters.[J]. Brain Behavior&Immunity,2018,70(1):61-75. DOI:10. 1016/j. bbi.2018.02.013.
[12]徐艳玲,王彤,刘波,等.综合性医院2010-2016年痰培养病原菌分布及细菌耐药性分析[J].中国医药,2018,13(11):1733-1737.
[13]范丽萍,孔祥文,鲁姝,等.痰热清注射液联合抗菌药物治疗医院获得性肺炎效果及安全性的Meta分析[J].中国医药,2018,13(11):1642-1645.
[14]洪林杰,黄种杰,范洪涛,等.老年慢性阻塞性肺疾病患者合并呼吸机相关性肺炎的病原菌分布变迁及耐药性分析[J].疑难病杂志,2018,17(3):226-229. DOI:10. 369/j. issn. 1671-6450. 2018.03.003.
[15]Van der PT, van de Veerdonk FL, Scicluna BP, et al. The immunopathology of sepsis and potential therapeutic targets[J]. Nature reviews Immunology, 2017, 17(7):407-420. DOI:10. 1038/nri.2017.36.
[16] Starr ME,Saito M,Evers BM,et al. Age-associated Increase in cytokine production during systemic inflammation-II:The role of IL-1(3in age-dependent IL-6 upregulation in adipose tissue[J]. J Gerontol A Biol Sci Med Sci, 2015, 70(12):1508. DOI:10.1093/gerona/glu197.
[17]韩朋飞,赵嘉,党治国,等.氨溴索辅助治疗成人重症肺炎疗效及其对肺功能指标、炎性因子的影响[J].疑难病杂志,2018,17(1):10-13. DOI:10.3969/j.issn. 1671-6450.2018.01.003.
[18] Marti C,Garin N,Grosgurin 0,et al. Prediction of severe community-acquired pneumonia:a systematic review and meta-analysis[J]. Critical Care, 2012, 16(4):R141. DOI:10.1186/cc11447.
[19]顾鑫亮.C反应蛋白联合降钙素原诊断肺炎致脓毒症的价值研究[J].中国继续医学教育,2017,9(15):63-65.
[20]高宏光,唐时元,朱姝姮,等.血清降钙素原、C反应蛋白对转诊肺炎合并脓毒症患者预后的预测价值分析[J].华西医学,2013,28(9):1342-1344.
[21]贾建超,张文平,杨金坡,等.肺炎继发脓毒症患者血清降钙素原和C反应蛋白变化及预后因素分析[J].中华实用诊断与治疗杂志,2018,32(2):144-147. DOI:10. 13507/j. issn. 1674-3474.2018.02.011.
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