| 丁伟超.红细胞分布宽度、胆碱酯酶、降钙素原对老年重症社区获得性肺炎患者28天死亡风险的预测价值[J].安徽医药,待发表. |
| 红细胞分布宽度、胆碱酯酶、降钙素原对老年重症社区获得性肺炎患者28天死亡风险的预测价值 |
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| 投稿时间：2023-04-17 录用日期：2023-05-29 |
| DOI： |
| 中文关键词: 老年 重症社区获得性肺炎（SCAP） 红细胞分布宽度（RDW） 胆碱酯酶（CHE） 降钙素原（PCT） 预测价值 |
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| 中文摘要: |
| 探讨红细胞分布宽度（RDW）、胆碱酯酶（CHE）、降钙素原（PCT）对老年重症社区获得性肺炎（SCAP）患者28天死亡风险的预测价值。方法 回顾性分析2016年1月~2021年12月期间入住徐州医科大学附属医院的86例老年SCAP患者的临床资料。根据28天转归情况将患者分为生存组（n=50）与死亡组（n=36）。比较两组患者的一般资料以及入院24小时内的化验结果。结果 死亡组患者的急性生理与慢性健康（APACHE Ⅱ）评分、序贯器官衰竭（SOFA）评分、白细胞计数（WBC）、中心粒细胞计数（NEU）、RDW、PCT、C-反应蛋白（CRP）、白介素-6（IL-6）、乳酸（LAC）大于生存组，血小板计数（PLT）、白蛋白（ALB）、CHE、PH值、氧合指数（PaO2/FiO2）小于生存组，差异存在统计学意义（P<0.05）。两组患者的性别、年龄、合并基础病例数、淋巴细胞计数（LYM）、血红蛋白（HGB）、红细胞比容（HCT）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TBIL）、直接胆红素（DBIL）、血尿素氮（BUN）、血肌酐（Scr）的差异无统计学意义（P>0.05）。多因素Logistic回归分析显示RDW、CHE、PCT是老年SCAP患者死亡的独立危险因素（P＜0.05）。Spearman 相关分析显示，RDW与PCT呈正相关（r=0.300, P=0.005），RDW与CHE呈负相关（r=-0.301, P=0.005）。ROC曲线分析显示RDW、CHE、PCT预测老年SCAP患者死亡的AUC分别为0.752、0.711、0.750。联合指标行ROC曲线分析显示RDW+CHE、RDW+PCT、CHE+PCT、RDW+CHE+PCT预测老年SCAP患者死亡的AUC分别为0.807、0.873、0.840、0.916，联合指标对老年SCAP患者死亡的预测能力大于单一指标，RDW+CHE+PCT三项联合指标的预测能力最强。结论 RDW和/或PCT升高、CHE降低是老年SCAP患者死亡的高危因素。而且，RDW、CHE、PCT对老年SCAP患者的28天死亡风险存在预测价值，各指标联合预测价值更高。 |
| 英文摘要: |
| Objective: To investigate the predictive value of red blood cell distribution width (RDW), cholinesterase (CHE) and procalcitonin (PCT) for 28-day mortality risk in elderly patients with severe community acquired pneumonia (SCAP). Method:The clinical data of 86 elderly patients with SCAP admitted to the Affiliated Hospital of Xuzhou Medical University from January 2016 to December 2021 were retrospectively analyzed. According to 28-day outcome, the patients were divided into survival group (n=50) and death group (n=36). General information and laboratory results within 24 hours after admission were compared between the two groups. Result: Acute physiology and chronic health evaluation(APACHE II) score, aequential organ failure assessment(SOFA) score, white blood cell count(WBC), neutrophil count(NEU), RDW, PCT, C-reactive protein(CRP), interleukin-6(IL-6) and lactic acid(LAC) in the death group were higher than those in the survival group. Blood platelet count(PLT), albumin(ALB), CHE, PH value and oxygenation index(PaO2/FiO2 ) were lower than those in the survival group. The differences were statistically significant (P<0.05). There were no significant differences in gender, age, number of combined base cases, lymphocyte count(LYM), hemoglobin(HGB), hematocrit(HCT), alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), direct bilirubin(DBIL), blood urea nitrogen(BUN) and serum creatinine(Scr) between the two groups (P>0.05). Multivariate Logistic regression analysis showed that RDW, CHE and PCT were independent risk factors for death in elderly patients with SCAP (P＜0.05). Spearman correlation analysis showed that RDW was positively correlated with PCT (r=0.300, P=0.005), RDW was negatively correlated with CHE (r=-0.301, P=0.005). ROC curve analysis showed that the AUC of RDW, CHE and PCT for predicting death in elderly patients with SCAP were 0.752, 0.711 and 0.750 respectively. ROC curve analysis of combined indicators showed that the AUC of RDW+CHE, RDW+PCT, CHE+PCT and RDW+CHE+PCT for predicting death in elderly patients with SCAP were 0.807, 0.873, 0.840 and 0.916 respectively. The predictive ability of the combined indicator for death in elderly patients with SCAP was greater than that of the single indicator, and RDW+CHE+PCT had the strongest predictive power. Conclusion: Increased RDW and/or PCT and decreased CHE are high risk factors for death in elderly patients with SCAP. In addition, RDW, CHE and PCT have predictive value for 28-day mortality risk in elderly patients with SCAP , and the combined predictive value of each index is higher. |
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