The Value Of PCT,IL-6 And CRP/ALB Ratio In The Diagnosis And Prognosis Of Severe Pneumonia

Objective: Through the analysis of PCT,IL-6 and CRP/ALB ratio,CRP,NGAL and other biomarkers at admission,to explore the value of diagnosis and prognosis of severe community-acquired pneumonia.Methods: Retrospective analysis of pneumonia patients and severe community-acquired pneumonia hospitalized in our hospital from December 2018 to December 2020.Cases of other infectious diseases,malignant tumors and so on were excluded.A total of 174 patients were divided into severe community-acquired pneumonia group and common pneumonia group according to the severity of the disease.There were 90 cases in severe community-acquired pneumonia group and 84 cases in common pneumonia group.During the observation period of 28 days,severe community-acquired pneumonia was divided into deterioration group(n = 50)and improvement group(n = 40)according to the outcome.The basic data of the two groups were collected and the results of PCT,CRP,IL-6,blood routine,albumin,CRP/ALB ratio,D-dimer and NGAL were collected within 24 hours after admission,and the CRP/ALB ratio and NEUT/LYM ratio NLR were calculated.The value of single index and combined index in evaluating the prognosis of severe pneumonia by ROC curve.Logistic regression analysis was used to analyze the factors affecting the prognosis of severe community acquired pneumonia.P<0.05 is considered statistically significant.Results: There was no significant difference in sex,age,nationality and other basic data between severe community-acquired pneumonia group and common pneumonia group(P > 0.05).The levels of PCT,CRP,CRP/ALB ratio and NLR in severe community-acquired pneumonia group were higher than those in common pneumonia group,and ALB in severe community-acquired pneumonia group was lower than that in common pneumonia group,the difference was statistically significant(P<0.05).There was no significant difference in WBC,NEUT,LYM,IL-6,NGAL,APACHEII score and D-dimer between the two groups(P > 0.05).The top three pathogens detected in sputum specimens from patients with severe community-acquired pneumonia were Acinetobacter baumannii(39 %),Klebsiella pneumoniae subspecies(11 %)and Pseudomonas aeruginosa(7 %);Comparison of basic data of sex,age and nationality between improvement group and deterioration group in severe community-acquired pneumonia group,there was no significant difference(P > 0.05).There was no significant difference in WBC,LYM,NEUT,NLR,D-dimer and scores of APACHEII between the improvement group and the deterioration group(P > 0.05).The levels of PCT,CRP,ALB,IL-6,NGAL and CRP/ALB in the deterioration group were higher than those in the improvement group,The ALB in the improvement group was higher than that in the deterioration group,the difference was statistically significant(P < 0.05).The value of ROC curve analysis of single index and combined index in predicting the prognosis of severe community-acquired pneumonia,the prediction value of PCT is the best in single index,and the area under ROC curve is the largest,which is 0.657.The sensitivity is 54%,the specificity is 77.5%,and the critical value is 2.84ng/ml.When the two indexes are combined,the predictive value of CRP/ALB+IL-6 is the best,and the area under the ROC curve is 0.694,the sensitivity is 72%,and the specificity is 65%.When the three indexes were detected together,the predictive value of PCT+IL-6 + CRP/ALB was the best,the area under the ROC curve was 0.676,the sensitivity was 66.00%,and the specificity was 67.5%.When CRP/ALB+PCT+NGAL+IL-6 combined detection,the area under ROC curve was 0.679,the sensitivity was 82%,and the specificity was 50%.Logistic regression analysis showed that the independent risk factors of poor prognosis in patients with severe community acquired pneumonia were high PCT and high IL-6(OR > 1).Conclusions:1.Compared with patients with severe community-acquired pneumonia and common pneumonia,PCT,CRP,CRP/ALB and NLR were higher in patients with severe pneumonia,which increased with the aggravation of pneumonia,the level of ALB was lower than that in patients with common pneumonia,and decreased with the aggravation of the disease.These five indexes can be used as a reference in the early diagnosis of severe community-acquired pneumonia.2.The combined detection of PCT,IL-6 and CRP/ALB has predictive value for the prognosis of severe community-acquired pneumonia.3.High PCT and high IL-6 are independent risk factors for poor prognosis in 28 days of severe community-acquired pneumonia.