The Application Value Of Of Early Detection Of Serum Cortisol And Copeptin In Community Acquired Pneumonia

ObjectiveTo explore application value of early detection of severity evaluation and prognosis of cortisol and copeptin in serum of patients with community acquired pneumonia(CAP).MethodsFrom June 2014 to June 2015, chosing the patients of clinical diagnosis of CAP in department of respiratory medicine, General Hospital of Guangzhou Military Command, patients who met the exclusion criteria were excluded. Cortisol, copeptin, C-reactiveprotein(CRP), procalcitonin(PCT), TNF-α, IL-1β and IL-10 were detected in 110 patients with CAP on the 1st and 4th day of hospitalization and 26 healthy volunteers on the day of physical examination. Patients with CAP were divided into general pneumonia group (54 cases) and severe pneumonia group(56 cases) by the severity of CAP, survival group (82 cases)and death group(28 cases) by clinical outcome. Analyses of differences of all indicators in each group were investigated. CURB-65, Peumonia Severity Index (PSI), APACHEⅡ were scored in the patients with CAP. Receiver operating characteristic (ROC) curve of each indicator was created to analyse the diagnosis value of severe pneumonia(SCAP) and prognosis value of risk of death in CAP.Results(1)①The level of CRP of the 1st day was significantly higher in the severe pneumonia group and the general pneumonia group than in the control group (P=0.000, P=0.000),the level of CRP of the 4th day was significantly higher in the severe pneumonia group than in the general pneumonia group at the same period (P=0.000), but there was no significance between the severe pneumonia group and the general pneumonia group in the level of CRP of the 1st day (P=0.261). The level of CRP of the 1st and 4th day were significantly higher in the death group than in the survival group at the same period (P=0.000, P=0.000).The level of PCT was significantly higher in the severe pneumonia group and the general pneumonia group than in the control group (P=0.000, P=0.000), the level of PCT of the 1st and the 4th day were significantly higher in the severe pneumonia group than in the general pneumonia group at the same period (P=0.000, P=0.000). The level of PCT of the 1st and the 4th day were significantly higher in the death group than in the survival group at the same period (P=0.000,P=0.000)②The level of cortisol, copeptin were significantly higher in the severe pneumonia group and the general pneumonia group than in the control group, the level of cortisol, copeptin of the 1 st and the 4th day were significantly higher in the severe pneumonia group than in the general pneumonia group at the same period (P＜0.05). The level of cortisol of the 1st and the 4th day was were significantly higher in the death group than in the survival group at the same period (P=0.000, P=0.000),the level of copeptin of the 4th day was significantly higher in the death group than in the survival group at the same period (P=0.000), there was no significance between the death group and the survival group in the level of copeptin on the 1st day (P=0.058)(2) The level of cortisol, copeptin, PCT showed positive correlations with CURB-65, PSI, APACHE Ⅱ score systems.(3) The ROC for diagnosing SCAP showed that the AUC value of cortisol of the 1st day (AUC=0.864) was similar to PCT (AUC=0.784) and copeptin (AUC=0.753) (P＞0.05), while they were significantly higher than CRP(AUC=0.607) (F＜0.05).The ROC for predicting the death risk showed that the AUC value of cortisol of the 1st day (AUC=0.875) was significantly higher than CRP (AUC=0.673),PCT (AUC=0.722),copeptin (AUC=0.620) (P＜0.05).The ROC for diagnosing SCAP showed that the AUC value of cortisol, copeptin of the 4th day (AUC=0.894, AUC=0.886) were similar (P＞0.05), but they were both significantly higher than CRP(AUC=0.774), PCT (AUC=0.803) (P＜0.05). The ROC for predicting the death risk showed that the AUC value of cortisol of the 4th day(AUC=0.810)was similar to PCT (AUC=0.773), CRP(AUC=0.766)and copeptin (AUC=0.768) (P＞0.05)②The ROC for diagnosing SCAP showed that the AUC value of combining detection of cortisol and copeptin of the 1st day (AUC=0.868) was similar to single cortisol and single PCT (P＞0.05), but it was significantly higher than single copeptin (P＜0.05). The ROC for predicting the death risk showed that the AUC value of combining detection of cortisol and copeptin of the 1st day (AUC=0.872) was similar to single cortisol (P＞0.05), but it was significantly higher than single copeptin, single PCT (P＜0.05). The ROC for diagnosing SCAP showed that the AUC value of combining detection of cortisol and copeptin of the 4th day (AUC=0.915) was similar to single cortisol, single copeptin (P＞0.05),but it was significantly higher than single PCT (P＜0.05).The ROC for predicting the death risk showed that the AUC value of combining detection of cortisol and copeptin of the 4th day (AUC=0.826) was similar to single cortisol, single copeptin, single copeptin (P>0.05)ConclusionEarly detection of serum cortisol and copeptin showed positive correlations with severity of CAP. They had a certain reference value of the diagnosis for SCAP and prognosis for the death risk. The value of the the diagnosis for SCAP and prognosis for the death risk of combining detection of cortisol and copeptin was not superior to single detection of cortisol or copeptin.