血清降钙素原、C-反应蛋白和白细胞介素6联合检测对脓毒症预后评估的临床价值

Predictive value of combined detection of PCT, CRP and IL-6 for prognosis of sepsis

  • 摘要: 目的 分析血清降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)和白细胞介素6(interleukin 6,IL-6)联合检测对脓毒症预后评估的临床价值。 方法 回顾性收集2005年1月-2015年1月本院收治的162例脓毒症患者。根据患者入院后28 d转归分为生存组(83例)和死亡组(79例)。比较两组间PCT、CRP、IL-6、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)和急诊脓毒症死亡风险评分(mortality in emergency department sepsis,MEDS)差异,并比较PCT、CRP和IL-6评估预后的能力。 结果 162例年龄19~83(57.06±15.37)岁,男102例(63.0%),女60例(37.0%)。死亡组并发心血管疾病、中枢神经疾病和消化道疾病例数高于生存组(P< 0.05)。死亡组的PCT、CRP、IL-6、SOFA、APACHEⅡ和MEDS评分数值高于生存组(P< 0.05)。将PCT、CRP和IL-6联合检测时用于判断脓毒症预后的ROC曲线下面积(area under ROC curve,AUC)为0.955,大于PCT(AUC=0.941)、CRP(AUC=0.780)和IL-6(AUC=0.884)单独检测时的面积。联合检测的敏感度(86.5%)、特异度(96.4%)、阳性预测值(95.6%)和阴性预测值(85.1%)均大于单独检测PCT(敏感度77.2%,特异度95.2%,阳性预测值93.8%,阴性预测值81.4%)、CRP(敏感度72.2%,特异度83.1%,阳性预测值80.2%,阴性预测值75.8%)和IL-6(敏感度86.1%,特异度72.3%,阳性预测值74.7%,阴性预测值84.5%)。 结论 PCT、CRP和IL-6联合检测较单独检测能更有效地评估脓毒症预后。

     

    Abstract: Objective To analyze the predictive value of combined detection of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) for prognosis of sepsis. Methods One hundred and sixty-two patients with spesis were collected retrospectively from January 2005 to January 2015 in Chinese PLA General Hospital.All patients were divided into survival group (n=83) and death group (n=79) according to the outcome at 28 days after admission.The differences of PCT, CRP, IL-6, SOFA score, APACHEⅡscore and MEDS score were compared between two groups.The accuracy of PCT, CRP and IL-6 in prediction of prognosis of sepsis was also evaluated. Results Of the 162 patients, there were 102 males (63.0%) and 60 females (37.0%) with age ranging from 19 to 83 years average age of (57.06±15.37) years old.The number of patients with angiocardiopathy, central nervous diseases, digestive diseases, PCT, IL-6, CRP, SOFA score, APACHEⅡ score and MEDS score in death group were significantly higher than survival group (P< 0.05).The area under ROC curve (AUC) for the prognosis of sepsis was 0.955 when PCT, CRP and IL-6 were detected in combination, which was higher than the AUC of single detection of PCT (AUC=0.941), CRP (AUC=0.780) and IL-6(AUC=0.884).Sensitivity (86.5%), specificity (96.4%), positive predictive value (+PV, 95.6%) and negative predictive value (-PV, 85.1%) of combined detection were higher than single detection of PCT (sensitivity 77.2%, specificity 95.2%, +PV 93.8%, -PV 81.4%), CRP (sensitivity 72.2%, specificity 80.2%, +PV 75.8%, -PV 75.8%) and IL-6 (sensitivity 86.1%, specificity 72.3%, +PV 74.7%, -PV 84.5%). Conclusion PCT, CRP, IL-6 are important factors for predicting the prognosis of sepsis.The combined detection of PCT, CRP and IL-6 is more effective than single detection in estimating prognosis of sepsis.

     

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