Significance of using procalcitonin combined with acute physiology and chronic health evaluation Ⅱ score to estimate prognosis of elderly patients with sepsis / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the significance of using procalcitonin (PCT) combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores to estimate the prognosis of elderly patients with sepsis. Methods One hundred and fourteen elderly patients with sepsis admitted into the Department of Intensive Care Unit (ICU) of 13th Division Xinjiang Production and Construction Corps Red Star Hospital from January 2011 to December 2017 were enrolled, general information of all patients [sex, age, body mass index (BMI), smoking, drinking alcohol, site of infection, underlying disease or complication, education level and marital status], vital signs (pulse, respiration frequency, pH value, body temperature, oxygenation index, diastolic blood pressure, systolic blood pressure), blood and biochemical indicators [blood sugar, high-density lipoprotein (HDL) and low-density lipoprotein (LDL)], D-dimer, PCT, C-reactive protein (CRP), APACHE Ⅱ, chronic health score (CHS) were recorded and survival situation of all patients after entering the study for 28 days. Univariate and multivariate analyses were used to analyze the prognostic factors of elderly patients with sepsis, and the receiver operating characteristic curve (ROC) was drawn to evaluate the diagnostic efficacy of the factors in sepsis. Results Within 28 days from admission to hospital, 64 patients (44.44%) died, 80 patients (55.56%) survived, and there were no significant differences in the sex, age, BMI, infected site, underlying disease or complication, education level, marital status, smoking, drinking alcohol, pulse, respiration frequency, pH, body temperature, oxygenation index, blood pressure, blood glucose, HDL, LDL and infection type in the comparisons between the survival and death groups (all P > 0.05). Compared with the survival group, the D-dimer, PCT, CRP, APACHE Ⅱ, mechanical ventilation ratio were higher in the death group [D-dimer (mg/L):3.6±1.1 vs. 3.2±1.2, PCT (mg/L): 15.4±3.5 vs. 4.1±1.4, CRP (ng/L): 637.0±8.9 vs. 596.0±9.6, APACHEⅡ:31.4±5.5 vs. 16.4±4.5, proportion of mechanical ventilation: 87.5% (56/64) vs. 56.2% (45/80), all P < 0.05];multivariate analyses showed that PCT, APACHEⅡ and proportion of mechanical ventilation were independent risk factors of the prognosis of sepsis [PCT: odds ratio (OR) = 4.126, 95% confidence interval (95%CI) = 2.045-6.115, P = 0.000; APACHEⅡ: OR = 2.935, 95%CI = 1.237-4.118, P = 0.001; mechanical ventilation: OR = 2.012, 95%CI =1.068-3.048, P = 0.034, all P < 0.05]. The PCT, APACHE Ⅱ and PCT combined with APACHEⅡ all can be used to diagnose the prognosis of senile sepsis, and the diagnostic value of PCT combined with APACHEⅡ was the largest [area under the ROC curve (AUC) = 0.946, 95%CI = 0.894-0.971, sensitivity = 86.7%, specificity = 90.8%, P = 0.000]. Conclusion PCT combined with APACHE Ⅱscore can be used to estimate the prognosis of elderly patients with sepsis.