Expression Level Of Serum Procalcitonin, C-reactive, Lactate In Patients With Community Acquired Pneumonia Complicated With Sepsis

Objective:To analyze the expression level of serum procalcitonin, C-reactive protein, lactate in patients with community acquired pneumonia. To explore the clinical value between the severity of community acquired pneumonia and procalcitonin, C-reactive protein, lactate.Methods:The clinical date of 100 cases from December 2013 to July 2014 in the second central hospital of Baoding. Meanwhile, 20 healthy individuals were served as the controls. Community-acquired pneumonia patients were divided into three or four groups according to diffrent severity assessment criteria(including the pneumonia severity index、sepsis score).The variance of procalcitonin, C-reactive protein, lactate levels was compared among the groups; All patients were divided into the survivor and death group according to whether they survived within 2 weeks. the differences of serum PCT, CRP, LAC and PSI score were compared in different groups. The receiver operating characteristic curve was used to assess the diagnostic value of the PCT, CRP and PSI score to predict sepsis. Spearman correlation analysis were used to analysis the correlations between PCT, CRP, LAC and PSI score respectively.Results:The levels of procalcitonin, C-reactive protein, lactate were increased in septic patients compared to non-septic patients and progressively elavated by the severity of sepsis patients.PCT levels and PSI scores were significant different among the non-sepsis group,mild sepsis group, severe sepsis group and septic shock group(P<0.05,respectively).CRP levels were significant different among the mild sepsis group, severe sepsis group and septic shock group(P<0.05,respectively), however, CRP levels were not significant different between non-sepsis group and mild sepsis group. LAC levels were different among the control group, non-sepsis group, mild sepsis group, severe sepsis group and septic shock group, The levels of LAC were elavated by the severity of sepsis patients. Compared with the survivor group, the levels of serum PCT, CRP, LAC and PSI scores increased obviously in death groups(P < 0.05). The receiver operating characteristic curve for PCT,CRP,PSI score to predict pneumonia concurrent septic shock had an area under the curve of 0.916,0.852,and 0.930,respectively. At a PCT cutoff level of 14.28ug/L or greater,a CRP cutoff level of 173.05mg/L or greater and a PSI score cutoff level of 108.5 points or greater, the sensitivity of the PCT, CRP and PSI score for detecting pneumonia concurrent septic shock were 90.9%, 81.8% and 90.9%, respectively, and the specificity were 82.0%, 71% and 79.8%, respectively. The receiver operating characteristic curve for PCT, CRP, PSI score to predict pneumonia concurrent severe sepsis and septic shockhad an area under the curve of 0.880, 0.883 and 0.898, respectively. At a PCT cutoff level of 1.42ug/L or greater, a CRP cutoff level of 143.35mg/L or greater and a PSI score cutoff level of 101.5 points or greater, the sensitivity of the PCT, CRP and PSI score for detecting pneumonia concurrent severe sepsis and septic shock were 84.6%, 82.1% and 84.6%, respectively, and the specificity were 72.1%, 77%and 88.5%, respectively. The receiver operating characteristic curve for PCT, CRP, PSI score to predict pneumonia concurrent sepsis had an area under the curve of 0.875, 0.728 and 0.838,respectively. At a PCT cutoff level of 0.53ug/L or greater,a CRP cutoff level of 66.05mg/L or greater and a PSI score cutoff level of 84.5 points or greater, the sensitivity of the PCT,CRP and PSI score for detecting pneumonia concurrent sepsis were 88.4%, 82.6% and 83.7%, respectively, and the specificity were 71.4%, 50%and 78.6%, respectively. The levels of PCT, CRP, LAC were positively correlated with PSI score(r=0.602, 0.655, 0.500, P<0.01, respectively).Conclusion:procalcitonin, C-reactive protein, lactate levels are correlateed with the severity of community-acquired pneumonia patients. Dynamic measurement of procalcitonin, C-reactive protein,l actate levels may be helpful to evaluate community-acquired pneumonia patients’ condition.