血清降钙素原联合PIRO评分预测急诊血流感染预后的价值  

Prognostic analysis of serum PCT combined with PIRO score in emergency patients with bloodstream infection

作　　者：马丽平 崔北辰 刘妍[1] 王聪[1] 赵斌[1] Ma Li-ping;Cui Bei-chen;Liu Yan;Wang Cong;Zhao Bin(Emergency Department,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院急诊科,北京100035

出　　处：《中国急救医学》2021年第6期470-473,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨血清降钙素原(procalcitonin,PCT)联合PIRO评分对急诊血流感染(BSI)患者预后的预测价值。方法回顾性入选2018年1月1日至2020年9月30日在北京积水潭医院急诊科就诊血流感染患者共254例,按入院后28 d内是否存活分为存活组(191例)和死亡组(64例),分别检测血清PCT、计算PIRO评分,用受试者工作特征(ROC)曲线分析血清PCT、PIRO评分单独及联合预测急诊血流感染患者预后的价值。结果 254例急诊血流感染患者,存活组192例(男101例,女91例),平均年龄76.0(63.0-82.3)岁;死亡组62例(男39例,女23例),平均年龄78.5(70.0-83.0)岁,两组比较差异无统计学意义(P>0.05)。死亡组血清PCT 9.96(4.28-15.80) ng/m L、PIRO评分17.0(15.0-19.0)分明显高于存活组血清PCT 1.05(0.40-5.07) ng/m L、PIRO评分7.0(5.0-10.0)分(P<0.01)。ROC曲线分析显示,血清PCT、PIRO评分及血清PCT联合PIRO评分可以预测血流感染患者死亡,ROC曲线下面积(AUC)分别为0.805 (95%CI0.738-0.872)、0.917(95%CI 0.860-0.974)、0.927(95%CI 0.874-0.980)。以血清PCT水平2.6ng/m L为界值,对急诊血流感染死亡的预测敏感度为83.9%,特异度为72.9%,阳性预测值和阴性预测值分别为50.0%和93.3%。以PIRO评分13.50分为界值预测急诊血流感染死亡预测的敏感度为85.5%,特异度为94.3%,阳性预测值和阴性预测值分别为82.8%和92.1%。结论血清PCT联合PIRO评分对急诊血流感染患者预后具有较好的预测价值。Objective To investigate the prognosis of serum procalcitonin( PCT) combined with PIRO score in the patients with emergency bloodstream infection( BSI). Methods From January1,2018 to September 30,2020 in emergency department of Beijing Jishuitan hospital,a total of 254 patients with BSI were retrospectively analyzed and were divided into survival group( 191 cases) and death group( 64 cases) according to whether lived within 28 days after admission. The serum PCT was detected and PIRO score was calculated respectively,the receiver-operating characteristic curve( ROC) was used to analyze the value of serum PCT,PIRO score and PCT combined with PIRO score in the patients with emergency BSI. Results Among the 254 patients with BSI in emergency department,192 cases( 101 males,91 females) were in the survival group with an average age of 76. 0( 63. 0-82. 3) years;62 cases( 39 males,23 females) were in the death group with an average age of 78. 5( 70. 0-83. 0) years. There was no statistical significance between the two groups( P>0. 05). Serum PCT of the death group was 9. 96( 4. 28-15. 80) ng/m L and PIRO score was 17. 0( 15. 0-19. 0)scores,which were significantly higher than those of the survival group [serum PCT 1. 05( 0. 40-5. 07)ng/m L and PIRO score 7. 0( 5. 0-10. 0) scores],and the difference was statistically significant( P<0. 01). ROC curve analysis showed that serum PCT,PIRO score and serum PCT combined PIRO scorecould predict the death of patients with BSI,and AUCs were 0. 805( 95% CI 0. 738-0. 872),0. 917( 95% CI 0. 860-0. 974),and 0. 927( 95% CI 0. 874-0. 980),respectively. The predictive sensitivity and specificity were 83. 9% and 72. 9%,respectively. The positive predictive value and negative predictive value were 50. 0% and 93. 3%,respectively,with a serum PCT level of 2. 6 ng/m L as the cut-off value. The sensitivity and specificity for predicting death in the patients of BSI with PIRO score of 13. 50 as the cut-off value was 85. 5% and 94. 3%,with a positive predictive value of 82. 8%and a negative pre

关 键 词：血流感染(BSI) 降钙素原(PCT) PIRO评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]