PCT联合SOFA评分早期动态监测对脓毒症患者预后的预测价值

何磊 穆根华 卢仲谦

[摘要] 目的 探討降钙素原（PCT）和序贯器官衰竭估计评分（SOFA）的早期动态监测对脓毒症患者预后的预测价值。 方法 前瞻性纳入2015年12月～2018年12月入我科脓毒症患者，记录患者一般资料、入院当日（D1）及次日（D2）的PCT水平和SOFA评分。随访28 d，记录机械通气时间、连续性肾脏替代治疗（CRRT）时间、血管活性药物使用及ICU住院时间。将患者分为存活组和死亡组，比较两组患者一般情况、PCT、SOFA组内及组间的差异;用ROC曲线下面积（AUC）评估D1、D2单独及联合PCT、SOFA对28 d死亡的预测价值。 结果 存活组D2的PCT水平显著低于死亡组（P=0.000）;存活组D2的SOFA评分与D1相比，显著下降（P=0.040）;死亡组D2的PCT水平比D1显著上升（P=0.045）。死亡组D1、D2的SOFA评分均显著高于存活组（P=0.000）。脓毒症患者D1预测28 d死亡的AUC最大值为0.714（PCT联合SOFA），PCT联合SOFA敏感度、特异度分别为68.9%、76.2%;D2预测28 d死亡的AUC最大值为0.837（PCT联合SOFA），PCT联合SOFA的敏感度、特异度分别为75.9%、91.4%。 结论 PCT联合SOFA评分对脓毒症患者的预测价值优于单一指标，且入院次日的PCT联合SOFA具有更高的预测价值。

[关键词] PCT;SOFA;脓毒症;预后

[中图分类号] R459.7          [文献标识码] A          [文章编号] 1673-9701（2020）15-0030-04

Predictive value of early dynamic monitoring of PCT combined with SOFA score in patients with sepsis

HE Lei MU Genhua LU Zhongqian CHEN Dongyu

Department of Critical Care Medicine，the First People's Hospital of Yancheng City in Jiangsu Province，Yancheng 224000，China

[Abstract] Objective To explore the predictive value of early dynamic monitoring of procalcitonin（PCT） and sequential organ failure assessment（SOFA） on the prognosis of sepsis patients. Methods Patients with sepsis who were admitted to our department from December 2015 to December 2018 were prospectively enrolled. The patient's general information，PCT level and SOFA score on the day of admission（D1） and the next day（D2） were recorded. They were followed up for 28 days. The mechanical ventilation time，continuous renal replacement therapy（CRRT） time， the time of vasoactive drugs use and the ICU hospitalization time were recorded. Patients were divided into survival group and death group. The differences in general situation， PCT and SOFA of patients within group and between groups were compared. The area under the ROC curve（AUC） was used to evaluate the predictive value of PCT，SOFA alone and PCT combined with SOFA on D1 and D2 for 28 d-death. Results The PCT level of the survival group was significantly lower than that of the death group on D2（P=0.000）. The SOFA score of the survival group on D2 was significantly lower than that on D1（P=0.040）. The PCT level of the death group on D2 was significantly higher than that on D1（P=0.045）. The SOFA score in the death group on D1 and D2 was significantly higher than that in the survival group（P=0.000）. The maximum AUC of PCT combined with SOFA on D1 in predicting 28 d-death was 0.714 in sepsis patients. The sensitivity and specificity of PCT combined with SOFA was 68.9% and 76.2%， respectively. The maximum AUC of PCT combined with SOFA on D2 in predicting 28 d-death was 0.837. The sensitivity and specificity of PCT combined with SOFA were 75.9% and 91.4%， respectively. Conclusion The predictive value of PCT combined with SOFA score in patients with sepsis is better than that of single index，and PCT combined with SOFA on the next day of admission has a higher predictive value.

[Key words] PCT; SOFA; Sepsis; Prognosis

脓毒症（Sepsis）是指宿主对感染的反应失调，引发危及生命的器官功能障碍[1]。脓毒症是重症医学科（ICU）的常见病和多发病，尽管近年来抗生素的应用和积极的液体复苏取得了长远的进步，但脓毒症的全球病死率仍高达40%～60%[2]。以第1天序贯器官衰竭估计评分（SOFA）和降钙素原（PCT）水平作为临床常用的反映病情严重程度的指标，均与脓毒症患者的预后相关[3]，但SOFA评分和PCT会随着患者对治疗的反应性而发生变化，影响临床对脓毒症患者预后的评估[4]，有研究显示第2天的SOFA评分更能反映膿毒症患者的预后[5]。……