Effects Of Procalcitonin,C-reaction Protein,and D-dimer On Prediction Of Prognosis Of Patients With Severe Pneumonia

Background and Objective:Severe pneumonia is a common infectious disease threatening human health seriously. Both of severe community-acquired pneumonia and hospital-acquired pneumonia have high morbidity and mortality. Recently, more and more biomarkers are used for assistance of diagnosis, severity evaluation and outcome prediction in severe pneumonia. In this study, we included83patients of severe pneumonia from The First Affiliated Hospital of Zhejiang University. The information of epidemiology, pathogen, biomarkers and clinical outcome were analyzed, to investigate the usefulness of serum level of procalcitonin (PCT), C-reaction protein (CRP), and D-dimer in prognosis of severe pneumonia. The study provides objective evidence for judgment of severity and evaluation of outcome in severe pneumonia.Methods:Eighty-three patients were included and grouped as survivors and non-survivors. We compared clinical characteristics, coexisting diseases, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores, mechanical ventilation and pathogen between two groups, as well as initial and maximum values of PCT, CRP and D-dimer; analyzed correlation between prognosis and increasing trend of PCT, CRP and D-dimer. receiver operating characteristic (ROC) curve was used to judge the predictive power of PCT, CRP and D-dimer for non-survivor.Results:Initial and maximum values of PCT, CRP and D-dimer were higher in non-survivors than survivors, and the difference reached statistical significance with P<0.01except for initial D-dimer. Increasing trend of PCT, CRP and D-dimer were associated with mortality, and the odds ratio(OR)(95%CI) were3.5(1.4-8.6),6.9(2.6-18.2) and11.5(3.1-43.2)(P<0.01) respectively. ROC analysis on prediction of mortality showed areas under the curve (AUC) of0.87,0.86,0.81and0.79for maximum PCT, APACHE Ⅱ scores, maximum CRP and maximum D-dimer respectively.Conclusion:PCT, CRP and D-dimer reflect the severity of illness in patients with severe pneumonia. Increasing trend of PCT, CRP and D-dimer suggest poor outcome. Maximum PCT is a good prognostic marker of mortality.