血清CRP、PCT联合CURB-65、SOFA评分对老年重症肺炎的预测价值

Predictive Value of Serum CRP, PCT Combined with CURB-65 and SOFA Scores in Elderly Patients with Severe Pneumonia

摘要: 目的：探讨血清C-反应蛋白(C-reactive protein, CRP)、降钙素原(Procalcitonin, PCT)联合CURB-65、序贯器官衰竭(Sequential organ failure, SOFA)评分对老年重症肺炎的预测价值。方法：选取在承德市中心医院住院的老年社区获得性肺炎191例。根据重症肺炎指南中的诊断标准，将患者分为重症肺炎组(49例)与非重症肺炎组(142例)，比较两组患者白细胞计数(WBC)、中性粒细胞百分数(NEUT%)、白蛋白(ALB)、CRP、PCT、CURB-65及SOFA评分。采用多因素Logistic回归分析影响患者病情严重程度的危险因素；分析血清CRP、PCT及CURB-65评分、SOFA评分对老年重症肺炎的诊断价值。结果：重症肺炎组血清CRP、PCT、中性粒细胞百分数(NEUT%)及CURB-65评分、SOFA评分均高于非重症肺炎组，白蛋白(ALB)低于非重症肺炎组(P < 0.05)。多因素Logistic结果显示,CRP、CURB-65评分及SOFA评分是病情严重程度的独立危险因素(P < 0.05)；ROC曲线分析结果显示，CRP、PCT、CURB-65评分、SOFA评分均对老年重症肺炎诊断有预测价值。血清PCT联合CURB-65及SOFA评分的预测价值最高(AUC为0.945，灵敏度 = 0.857，特异度 = 0.908)。结论：血清CRP、PCT、CURB-65与SOFA评分均可用于老年重症肺炎的早期预测，联合检测可显著提高诊断准确性，优于单一指标。

Abstract: Objective: To explore the predictive value of serum C-reactive protein (C-reactive protein, CRP), procalcitonin (Procalcitonin, PCT) combined with CURB-65 and sequential organ failure (Sequential organ failure, SOFA) scores in elderly patients with severe pneumonia. Methods: 191 elderly patients with community-acquired pneumonia in Chengde Central Hospital were selected. According to the diagnostic criteria in the guidelines for severe pneumonia, the patients were divided into two groups: severe pneumonia group (n = 49) and non-severe pneumonia group (n = 142). The scores of white blood cell count (WBC), neutrophil percentage (NEUT%), albumin (ALB), CRP, PCT, CURB-65 and SOFA were compared between the two groups. Multivariate Logistic regression analysis was used to analyze the risk factors affecting the severity of patients’ condition. The diagnostic value of serum CRP, PCT, CURB-65 score and SOFA score in elderly patients with severe pneumonia was analyzed. Results: Serum CRP, PCT, neutrophil percentage (NEUT%), CURB-65 score and SOFA score in the severe pneumonia group were higher than those in the non-severe pneumonia group, while albumin (ALB) was lower than that in the non-severe pneumonia group. Multivariate Logistic results showed that CRP, CURB-65 score and SOFA score were independent risk factors for the severity of the disease. The results of ROC curve analysis showed that CRP, PCT, CURB-65 score and SOFA score had predictive value in the diagnosis of severe pneumonia in the elderly. The predictive value of serum PCT combined with CURB-65 and SOFA score was the highest (AUC = 0.945, sensitivity = 0.857, specificity = 0.908). Conclusion: Serum CRP, PCT, CURB-65 and SOFA scores can be used for early prediction of severe pneumonia in the elderly. Combined detection can significantly improve the diagnostic accuracy, which is better than a single index.