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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (01) : 14 -20. doi: 10.3877/cma.j.issn.2096-1537.2021.01.003

所属专题: 文献

临床研究

临床指标与ICU老年肺部感染患者预后的关系
王皓1, 辛娜1, 许雪侠1, 殷志颖2, 王文姣3, 孙斌1, 马四清1,()   
  1. 1. 810007 西宁,青海省人民医院重症医学科
    2. 810000 西宁,青海大学研究生院
    3. 810599 青海互助,青海省互助县中医院急诊科
  • 收稿日期:2020-08-28 出版日期:2021-02-28
  • 通信作者: 马四清
  • 基金资助:
    青海省高原重症医学重点实验室项目(2020-81); 青海省科技创新创业人才项目(2020-66); 青海省科技厅重点研发与转化计划项目(2019-SF-132); 青海省卫生计生系统指导性计划课题(2018-wjzdx-07)

Relationship between clinical biomarkers and prognosis of geriatric patients with pneumonia in intensive care unit

Hao Wang1, Na Xin1, Xuexia Xu1, Zhiying Yin2, Wenjiao Wang3, Bin Sun1, Siqing Ma1,()   

  1. 1. Intensive Care Unit, Qinghai Provincial People's Hospital, Xining 810007, China
    2. Graduate School of Qinghai University, Xining 810007, China
    3. Huzhu County Hospital of TCM, Huzhu 810599, China
  • Received:2020-08-28 Published:2021-02-28
  • Corresponding author: Siqing Ma
引用本文:

王皓, 辛娜, 许雪侠, 殷志颖, 王文姣, 孙斌, 马四清. 临床指标与ICU老年肺部感染患者预后的关系[J/OL]. 中华重症医学电子杂志, 2021, 07(01): 14-20.

Hao Wang, Na Xin, Xuexia Xu, Zhiying Yin, Wenjiao Wang, Bin Sun, Siqing Ma. Relationship between clinical biomarkers and prognosis of geriatric patients with pneumonia in intensive care unit[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(01): 14-20.

目的

观察临床指标在预测ICU老年肺部感染患者预后中的作用。

方法

收集2017年1月1日至2018年12月31日在青海省人民医院ICU住院治疗的222例老年肺部感染患者的临床资料。统计患者入科时的性别、年龄、民族、急性生理与慢性健康状况(APACHE Ⅱ)评分、序贯器官衰竭评估(SOFA)评分、CURB-65评分、降钙素原(PCT)、B型利钠肽(BNP)、C反应蛋白(CRP)、白细胞计数(WBC)、血小板(PLT),以及出科时的最近一次的PCT、BNP、CRP、WBC及PLT。记录患者的ICU住院时间及出ICU时的预后情况。采用二元Logistic回归模型分析临床预后的危险因素。采用受试者工作特征曲线(ROC)分析各指标在预测患者预后中的敏感度、特异度以及Youden指数。

结果

存活组与死亡组的民族构成、性别构成、APACHE Ⅱ评分[(10(8,13)分 vs 19(16,23)分]、入科PCT[2.39(0.88,4.66)ng/ml vs 6.02(2.69,12.94)ng/ml]、入科BNP[702(367,1172)pg/ml vs 954(460,1496)pg/ml]、入科CRP[5.84(2.31,14.98)mg/dl vs 10.47(4.86,18.22)mg/dl]、出科PCT[1.47(0.56,2.65)ng/ml vs 6.33(1.98,12.54)ng/ml]、出科BNP[464(215,713)pg/ml vs 1414(412,2377)pg/ml]、出科CRP[3.35(1.40,7.09)mg/dl vs 5.10(2.75,11.98)mg/dl]比较,差异均有统计学意义(P<0.05)。自动出院和死亡的比例为39.19%。APACHE Ⅱ评分>15分组的病死率更高(75.51% vs 10.48%,P<0.001);PCT在出科时下降50%以上的患者的病死率更低(30.30% vs 46.34%,P<0.05);BNP在出科时下降50%以上的患者的病死率明显下降(18.75% vs 50.70%,P<0.001)。二元Logistic回归模型分析结果显示,SOFA评分(OR=2.775,P=0.001)、CURB-65评分(OR=10.052,P=0.001)、出科PCT(OR=1.189,P=0.029)、出科BNP(OR=1.002,P=0.001)为预后不良的危险因素。

结论

入院时APACHE Ⅱ评分>14.5分,SOFA评分>8.5分,CURB-65评分>3.5分,PCT>4.35 ng/ml,BNP>1155 pg/ml以及CRP>6.53 mg/dl可以明显增加ICU老年肺部感染患者的死亡风险。

Objective

To investigate predictive value of clinical markers in geriatric patients with pneumonia in ICU.

Methods

The clinical data of 222 patients admitted to the ICU of Qinghai Provincial People's Hospital from January 2017 to December 2018 was collected. Gender, age, ethnicity, APACHE Ⅱ score, SOFA score, CURB-65 score, PCT, BNP, CRP, WBC and PLT were recorded. The length of stay in ICU and prognosis of the patients were also recorded. The risk factors of clinical prognosis were analyzed by binary Logistic regression model. The sensitivity, specificity and Youden index of clinical predicting indicators were analyzed with the receiver operating characteristic curve (ROC).

Results

The APACHE Ⅱ [10(8, 13) vs 19(16, 23)], ethnicity, gender, PCT on admission [2.39(0.88, 4.66) vs 6.02(2.69, 12.94)], BNP on admission [702(367, 1172) vs 954(460, 1496)], CRP on admission [5.84(2.31, 14.98) vs 10.47(4.86, 18.22)], PCT at discharge [1.47(0.56, 2.65) vs 6.33(1.98, 12.54)], BNP at discharge [464(215, 713) vs 1414(412, 2377)], CRP at discharge [3.35(1.40, 7.09) vs 5.10(2.75, 11.98)] were significantly different between survival group and death group (P<0.05). The percentage of patients with against-advice discharge and death was 39.19%. Patients with APACHE Ⅱ score over 15 had a higher mortality rate (75.51% vs 10.48%). The mortality of patients who had a half decreased PCT level at discharge were lower (30.30% vs 46.34%). The mortality of patients who had a half decreased BNP at discharge were lower (18.75% vs 50.70%). Binary Logistic regression model analysis results showed that SOFA score (OR=2.775, P=0.001), CURB-65 score (OR=10.052, P=0.001), PCT at discharge (OR=1.189, P=0.029), BNP at discharge (OR=1.002, P=0.001) were independent risk factors for poor outcome.

Conclusion

The APACHE Ⅱ score over 14.5, SOFA score over 8.5, CURB-65 score over 3.5, PCT over 4.35 ng/ml, BNP over 1155 pg/ml, and CRP over 6.53 mg/dl can significantly increase the risk of death in geriatric patients with pneumonia in ICU.

表1 存活组与死亡组ICU老年肺部感染患者的临床特征比较[M(P25,P75),222例]
临床特征 存活组(135例) 死亡组(87例) 统计值 P
民族 7.849* 0.042

汉族(170例)

103 67

回族(22例)

18 4

藏族(24例)

10 14

撒拉族+蒙古族+土族(6例)

4 2
性别 χ2=6.619 0.010

男(143例)

78 65

女(79例)

57 22
年龄(岁)[72(66,78)] 71(64,77) 74(67,79) Z=-1.844 0.065
APACHE Ⅱ(分)[13(9,18)] 10(8,13) 19(16,23) Z=-9.991 <0.001
SOFA(分)[8(6,11)] 6(5,8) 11(10,12) Z=-10.032 <0.001
CURB-65(分)[3(3,4)] 3(2,3) 4(4,4) Z=-9.728 <0.001
住ICU时间(d)[8(5,14)] 7(5,12) 9(6,15) Z=-1.511 0.131
入科时

PCT(ng/ml)[3.37(1.37,7.24)]

2.39(0.88,4.66) 6.02(2.69,12.94) Z=-5.249 <0.001

BNP(pg/ml)[776(391,1321)]

702(367,1172) 954(460,1496) Z=-2.057 0.040

CRP(mg/dl)[7.66(2.68,17.34)]

5.84(2.31,14.98) 10.47(4.86,18.22) Z=-2.523 0.012

WBC(×109/L)[10.52(7.39,15.42)]

10.26(7.16,15.39) 10.67(7.64,15.60) Z=-0.395 0.693

PLT(×109/L)[146(90,221)]

145(94,231) 149(86,210) Z=-0.482 0.630
出科时

PCT(ng/ml)[2.23(0.91,5.68)]

1.47(0.56,2.65)a 6.33(1.98,12.54) Z=-7.283 <0.001

BNP(pg/ml)[549(289,1227)]

464(215,713)a 1414(412,2377)a Z=-6.638 <0.001

CRP(mg/dl)[4.07(1.89,8.93)]

3.35(1.40,7.09)a 5.10(2.75,11.98)a Z=-3.365 0.001

WBC(×109/L)[8.75(6.28,11.83)]

8.48(6.00,11.32)a 9.96(6.77,13.56)a Z=-1.793 0.073

PLT(×109/L)[152(95,229)]

152(101,231) 151(85,224) Z=-0.796 0.426
表2 各指标变化与ICU老年肺部感染患者预后死亡的关系[例(%)]
表3 ICU老年肺部感染患者预后二元Logistic回归分析结果
表4 ICU老年肺部感染患者各项指标在预测预后的AUC、敏感度、特异度及最大Youden指数界值
图1 ICU老年肺部感染患者入科指标在预测死亡的ROC曲线图
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