Value Of Blood Urea Nitrogen To Serum Albumin Ratio And Procalcitonin In Predicting The Severity And Prognosis Of Community-Acquired Pneumonia

Objective: To investigate the value of blood urea nitrogen to serum albumin ratio(BUN/ALB)and procalcitonin(PCT)in evaluating the severity and predicting the prognosis of patients with community-acquired pneumonia(CAP).Methods: According to the inclusion criteria of this study,we selected 224 patients with CAP who hospitalized in our Hospital from April 2017 to June 2019,the clinical data were retrospectively reviewed.We Collected the general situation;physical examination and laboratory results at admission or within 24 hours after admission;calculated BUN/ALB,CURB-65,pneumonia severity index(PSI);outcomes.The patients were divided into the severe community-acquired pneumonia group and non-severe community-acquired pneumonia group according to the severity of pneumonia,we compared blood urea nitrogen(BUN),serum albumin(ALB),BUN/ALB,PCT,CURB-65 score and PSI class in the two groups.Using the PSI scoring system,the patients were divided into mild severity,moderate severity and severe severity,BUN/ALB and PCT level were compared in the three groups.We analyzed the correlation between BUN/ALB,PCT and CURB-65 score,PSI scores using Spearman Rank Correlation Analysis.The patients were divided into the survival group and the death group according to whether the patient died within 28 days,clinical data were compared and analyzed in the two groups.Multivariate Logistic regression analysis was used to screen the high-risk factors of 28-day mortality in patients with CAP.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of BUN/ALB,PCT,CURB-65 score,PSI class,BUN/ALB combined with CURB-65,PCT combined with CURB-65 for 28-day mortality risk in patients with CAP.Results:1.The level of BUN,BUN/ALB,PCT,CURB-65 score and PSI class in severe community-acquired pneumonia group were significantly higher than the non-severe community-acquired pneumonia group,all P < 0.001.In severe community-acquired pneumonia group,the ALB were significantly lower than non-severe community-acquired pneumonia group,all P<0.001.2.Be grouped according to PSI score,the difference was statistically significant between different severity groups,the level of BUN/ALB,PCT increased with the pneumonia severity increases.3.The Spearman correlation analysis showed that BUN/ALB had a positive association with the CURB-65 score and PSI score(the correlation coefficients r=0.654,0.655,P<0.001).PCT had a positive association with the CURB-65 score and PSI score(r=0.451,0.514,P<0.001).4.The level of pulse frequency,respiratory rate,systolic blood pressure,white blood cell count(WBC),PCT,BUN,BUN/ALB,CURB-65 score and PSI class in the death group were higher than the survival group,all P<0.05.The incidence of pleural effusion and incidence of unawareness in the death group were higher than the survival group.In the death group,the HCT and ALB were lower than the survival group,all P<0.05.5.Multivariate logistic regression analysis indicated that BUN/ALB(odds ratios1.267,95%CI:1.060～1.514),respiratory rate(odds ratios 1.098,95%CI:0.986～1.222),unawareness(odds ratios 9.736,95%CI: 2.429～139.026),pleural effusion(odds ratios 16.085,95%CI: 1.835～139.253)were independent risk factors of deteriorated CAP patients respectively,all P<0.05.6.The AUC value of BUN/ALB,PCT,CURB-65 score,PSI class,BUN/ALB combined with CURB-65,PCT combined with CURB-65 for predicting death within 28 days in patients with CAP were 0.855,0.796,0.869,0.919,0.893 and0.887.There was no significant difference between BUN/ALB combined with CURB-65,PCT combined with CURB-65 and CURB-65(P>0.05).Conclusions:1.BUN/ALB、PCT can be used to evaluate the severity of CAP patients,the high level of BUN/ALB、PCT has positive correlation the severity of patients with CAP.2.BUN/ALB、PCT can be used as a predictor of short-term mortality of CAP patients,the high level of BUN/ALB、PCT predicting poor prognosis of patients with CAP.