| Objective:This study is to quantitatively detect the sputum procalcitonin(PCT)level of hospital acquired pneumonia(HAP)and ventilator-associated pneumonia(VAP)patients in adults,and the serum PCT are compared to analyze their diagnostic value for adult HAP/VAP.At the same time,the relationships between sputum PCT and serum PCT,curative effect,prognosis,etc,are analyzed.It aims to evaluate the clinical application value of sputum PCT quantitative detection in adult HAP and VAP.Methods:Adult HAP and VAP patients who were hospitalized in the intensive care unit(ICU),cardiothoracic surgery,cardiothoracic surgery ICU,neurosurgery,and neurosurgery ICU of our hospital from September 2020 to December 2021 were selected as the research subjects.The sputum of the patients were collected on the day or the second day when HAP/VAP was suspected and when the condition improved after treatment,and conducted quantitative detection of PCT in the sputum.At the same time,the test results of serum PCT,WBC,NEUT%,and sputum culture,the relevant clinical data,such as the patient’s past history,personal history,lung imaging manifestations,application of ventilator and antibiotics,whether or not to operate,length of operation,length of hospital stay,and prognosis,were collected.Based on the clinical data of the patients,they were divided into the following groups:(1)According to whether the infection was related to the ventilator,they were divided into HAP group and VAP group;(2)According to sputum culture results,they were divided into sputum culture positive group and sputum culture negative group;(3)According to the prognosis,they were divided into a good prognosis group and a poor prognosis group;(4)According to the course of disease,they were divided into two groups,at the early stage of the disease and after the improvement of the disease.Analyzing and comparing the differences of sputum PCT,serum PCT,WBC and NEUT%among the above groups;analyzing and comparing whether the sputum PCT and serum PCT levels decreased compared with the initial stage of the disease after the patients’ condition improved after anti-infection and other treatments;analyzing the correlation between sputum PCT and serum PCT,WBC,NEUT%;analyzing the correlations between sputum PCT,serum PCT and whether the patient was smoking,fever,underlying disease,operation,operation duration,prognosis,hospitalization days,and the correlation between sputum PCT concentration and sputum collection methods(natural expectoration method and disposable suction tube method).SPSS25.0 was used to draw ROC curve to analyze the diagnostic value of sputum PCT and serum PCT in adult HAP and VAP,and for statistical analysis of related data.Results:(1)A total of 151 patients with hospital acquired respiratory infection were collected in this study,including 105 cases of HAP and 46 cases of VAP,77 males and 74 females,aged(59.42±12.63)years,median hospital stay was 15 days,median sputum PCT level(0.58ng/mL)was higher than the median level of serum PCT(0.46ng/mL).The mean values of sputum PCT in males and females were 0.79ng/mL and 0.74ng/mL respectively,and the difference was not statistically significant(P>0.05).(2)There was no significant difference in sputum PCT level and WBC between HAP group and VAP group(P>0.05),but serum PCT and NEUT%had significant differences between the two groups(P<0.05).The median of serum PCT in the VAP group(2.55ng/mL)was significantly higher than that in the HAP group(0.2ng/mL).In addition,the data of sputum PCT and serum PCT were significantly different in HAP group and VAP group respectively(P=0.00).The median level of sputum PCT in the HAP group was significantly higher than the median of serum PCT.The median level of serum PCT was significantly higher than the median level of sputum PCT in the VAP group.(3)The difference of sputum PCT and serum PCT between the sputum culture positive group and the negative group was statistically significant(P<0.05),and the median levels were higher in the sputum culture positive group,which were 0.60ng/mL,1.13ng/mL.(4)The difference of serum PCT and NEUT%between the good prognosis group and the poor prognosis group was statistically significant(P<0.05),and the median levels were higher in the poor prognosis group,which were 1.55ng/mL and 87.90%.There was no significant difference in the sputum PCT and WBC between the two groups(P>0.05).(5)The difference of serum PCT,WBC,and NEUT%between the early onset group and the improved group was statistically significantly different(P<0.05),and the median levels were higher in the early onset,which were 2.24ng/mL and 12.19×10^9/L,87.90%.There was no significant difference in the sputum PCT level between the two groups(P>0.05).(6)There was no significant correlation between sputum PCT and serum PCT,WBC,NEUT%(P>0.05).(7)There was no significant correlation between sputum PCT and the way of sputum collection,prognosis,smoking,fever,underlying disease,operation,operation time and hospital stay(P>0.05).Serum PCT was significantly positively correlated with whether the patient had fever,operation time,hospital stay and prognosis(P<0.05).If the patient had fever,worse prognosis,and longer operation time,the serum PCT level would be higher,and the hospitalization time would be longer.(8)There were 60 positive sputum culture cases,including 24 HAP cases(accounting for 22.86%of the total HAP cases)and 36 VAP cases(accounting for 78.26%of the total VAP cases).Among the positive cases of sputum culture,28 cases(46.67%)were infected with single bacteria,32 cases(53.33%)were infected with mixed bacteria,and 29 cases(48.33%)were infected with multi-drug resistant bacteria,which including methicillin-resistant staphylococcus aureus(MRSA),extended-spectrum beta-lactamase(ESBLs)-producing enterobacteriaceae(Escherichia coli,Klebsiella pneumoniae),carbapenem-resistant bacteria(Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa).(9)The bacteria detected in the HAP group were mainly Klebsiella pneumoniae,Staphylococcus aureus,Acinetobacter baumannii,Pseudomonas aeruginosa,and Corynebacterium striatum;the bacteria detected in the VAP group were mainly Pseudomonas aeruginosa bacteria,Klebsiella pneumoniae,Acinetobacter baumannii,Stenotrophomonas maltophilia,Corynebacterium striatum.(10)The diagnostic value of sputum PCT and serum PCT for HAP/VAP in adults was evaluated by drawing ROC curves.Both sputum PCT and serum PCT had diagnostic value for adult HAP/VAP,and serum PCT was more valuable than sputum PCT(AUC blood PCT=0.67>AUC sputum PCT=0.60).When the critical value of serum PCT was 0.22ng/mL,the diagnostic efficiency was the best,and the sensitivity and specificity were 80.00%and 49.50%;when the critical value of sputum PCT was 0.42ng/mL,the diagnostic efficiency was the best,and the sensitivity and specificity were 80.00%and 48.35%.Conclusions:(1)The levels of sputum PCT and serum PCT have low value in the diagnosis of adult HAP/VAP,and can be used as auxiliary diagnostic.indicators.(2)In adult HAP/VAP,sputum PCT can’t be used as a curative effect assessment and predictive prognostic indicator,while serum PCT can be used as a curative effect assessment and predictive prognostic indicator.(3)The level of sputum PCT in HAP patients was significantly higher than that in serum PCT;the serum PCT level in VAP patients was significantly higher than that in sputum PCT.Both have advantages in different hospital-acquired lung infections. |
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