Study On The Application Value Of Serum CRP,PCT And SOFA Scores In Ventilator-associated Pneumonia

Objective: To explore the application value of serum C-reactive protein(CRP),procalcitonin(PCT)and sequential organ failure(sofa)score in the diagnosis,etiological analysis and prognosis of ventilator-associated pneumonia(VAP),provide reference basis for the diagnosis and evaluation of VAP,guide the clinical selection of effective indexes to diagnose and evaluate VAP,and improve the early diagnosis rate of VAP,Scientifically formulate and adjust the treatment plan to reduce the harm caused by VAP.Methods: 308 patients with mechanical ventilation treated in EICU of yijishan Hospital of Wannan Medical College from August 2018 to August 2021 were selected as the research objects.The levels of serum CRP and PCT were detected and the score of sofa was evaluated.According to the occurrence of VAP,the patients were divided into VAP group and non VAP group.The levels of serum CRP,PCT and SOFA score were compared between the two groups,and the value of single application and combined application of the three indexes in the diagnosis of VAP was analyzed by ROC curve.The pathogenic bacteria and clinical prognosis of VAP patients were counted.They were divided into Gram-negative bacteria group and Gram-positive bacteria group according to the type of pathogenic bacteria.They were divided into death group and survival group according to the 28 d death.The serum CRP,PCT levels and sofa scores of VAP patients in different pathogenic bacteria groups and different prognosis groups were compared,and the relationship between serum CRP,PCT levels and sofa scores and the type of VAP pathogenic bacteria was explored by Spearman correlation analysis Relationship between prognosis.Finally,Pearson correlation analysis was used to explore the relationship between serum CRP,PCT and SOFA score in VAP patients.Based on the above analysis,the clinical application value of CRP,PCT and SOFA score in VAP was comprehensively evaluated.Results:(1)before mechanical ventilation,there was no significant difference in serum CRP,PCT and sofa scores between the two groups(P > 0.05);At 48 h,72h and 120 h of mechanical ventilation,the scores of serum CRP,PCT and sofa in VAP group were significantly higher than those in non VAP group(P < 0.05).(2)ROC curve analysis showed that the area under the curve(AUC)of CRP was the lowest,0.786,and the best critical value was 10 mg / L;The second is PCT,AUC is 0.825,and the optimal critical value is 0.5 ng / ml;Score for sofa again,AUC was 0.892;The combined AUC of the three indexes was the highest,which was 0.956.The diagnostic sensitivity,specificity and accuracy were 97.85%,96.70% and 97.05% respectively,which were higher than that of a single index(CRP: 80.65%,68.40% and 72.13%;PCT: 80.65%,82.55% and81.79%;SOFA score: 90.32%,89.62% and 89.84%)(P < 0.05).(3)Sputum culture was positive in 72 of 93 VAP patients,with a positive rate of 77.42%,including 18 cases of Gram-positive bacteria infection(25.00%)and 54 cases of Gram-negative bacteria infection(75.00%).The scores of serum PCT and sofa in Gram-negative bacteria group were significantly higher than those in Gram-positive bacteria group(P < 0.05);Spearman rank correlation analysis showed that there was a positive correlation between serum PCT and sofa scores and gram-negative bacterial infection(P <0.05).(4)The 28 day mortality of VAP patients was 19.35%.There was no significant difference in the scores of serum CRP,PCT and sofa on the day of diagnosis between the prognosis death group and the survival group(P > 0.05);After 5 days of treatment,the scores of serum PCT and sofa in the survival group were lower than those in the death group(P <0.05),but there was no significant difference in the level of serum CRP between the two groups(P > 0.05).Spearman rank correlation analysis showed that the serum PCT and sofa scores of VAP patients after 5 days of treatment were positively correlated with 28 days of death(P < 0.05).(5)Pearson correlation analysis showed that there was a positive correlation between PCT and SOFA score(P < 0.05);There was no significant correlation between CRP and SOFA score(P > 0.05).Conclusion:(1)serum PCT,CRP and sofa scores can be used to assist in the diagnosis of VAP.Among the three single indexes,SOFA score has the most diagnostic value,followed by serum PCT and serum CRP.The combined application of the three is more helpful to improve the diagnostic accuracy of VAP.(2)Serum PCT and SOFA scores are closely related to the type and prognosis of pathogenic bacteria in VAP patients,and can be used to predict the type and prognosis of pathogenic bacteria.