| Objective:To assess the disease severity and prognosis value by observing the dynamic change of serum procalcitonin (PCT) and its clearance rate (PCTc) in the patients with ventilator associated pneumonia.Methods:A prospective observational study was conducted in adult ICU. A total of 128 patients admitted into our ICU from February 2012 to june 2014 with VAP were included in this study. Patients were divided into recovery group and deterioration group according to the therapeutic effect. The serum PCT and its clearance rate had been examined in both groups in ld,5d,7d and 9d after the VAP was diagnosed. The APACHE-Ⅱ scores were estimated within 24 hour in each group when VAP was diagnosed. The diagnostic and predictive performance of PCT, PCTc and APACHE-Ⅱ scores were assessed by the receiver operating characteristic curve (ROC). Results:APACHE Ⅱ scores in recovery group were significantly lower than those in the deterioration group (14.49±5.30 vs.18.90±5.30, P=0.000). There was no significant difference in PCT level(p.g/L) at 1 day after VAP was diagnosed between recovery group and deterioration group[2.84(0.81,6.43) vs.3.50(0.97,10.27),P=0.152].With prolonged treatment, PCT was gradually decreased in recovery group, while remained at higher level in deterioration group, which was significantly lowered at 5 days after VAP diagnosed in recovery group compared with that in the deterioration group [1.28(0.65,3.13) vs. 2.39(0.78,9.35), P=0.044]. PCTc maintained higher level in recovery group which was gradually increased with the improvement of the disease, and PCTc in deterioration group was lowered which was gradually decreased with the development of the disease. PCTc at 5,7,9 days in recovery group was significantly higher than that in deterioration group[5 d:50.43(20.39,80.60)% vs.-56.68(-286.28,172.92)%, P=0.024;7 d:54.01(5.70, 102.30)% vs.-76.91(-335.03,181.21)%, P=0.010; 9 d:63.88(25.93,101.80)% vs.-133.49(-547.20,280.16)%, P=0.002]. The area under ROC curve(AUC) of PCT5, PCT7, PCT9 predicting the prognosis was 0.591,0.683,0.746, respectively[95% confidence interval(95%CI) was 0.456-0.726(P=0.161),0.557-0.808(P=0.005), 0.631-0.860(P=0.000)]. When PCT9 was 5.65μg/L, the sensitivity of 95% and the specificity of 61%. The AUC of PCTc5, PCTc7 and PCTc9 was 0.648,0.685,0.729, respectively[95%CI was 0.513-0.783(P=0.028),0.555-0.815(P=0.006), 0.607-0.851(P=0.001)]. When PCTc9 was 92%,the sensitivity was 98% and the specificity was 71%. The AUC of APACHE Ⅱ score was 0.693(95%CI 0.578-0.808,P= 0.003). When APACHE Ⅱ score was 19.5, the sensitivity was 77% and the specificity was 58%. Conclusion:The increased levels of PCT in patients with VAP were associated with the poor control of infection and may indicate the deterioration of VAP, it also can reflect the activity of lung infection in time. Keep observing the dynamic change of PCT and analyzing PCTc is more useful. The PCTc levels may provide evidence of disease progression and helpful in risk stratification in patients with VAP, and lower level of PCTc may accompany serious infection and predict poor prognosis. |
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