The Application Of The Three Terms Of Infection And CPIS In The Diagnosis And Evaluation Of Community Acquired Pneumonia In Elderly Patients

Objective:Through detecting the level of plasma procalcitonin (PCT) and interleukin -6 (IL-6), high sensitive C-reactive protein (hs-CRP) in serum and improving the simplified clinical pulmonary infection score (CPIS) in elderly patients with community acquired pneumonia (community-acquired pneumonia, CAP) patients, explore their value in the diagnosis and severity evaluation for elderly CAP.Methods:1. In this study, collect 71 cases of elderly CAP patients (?65year) from April 2015 to October 2016 treated in the Second Affiliated Hospital of Kunming Medical University three respiratory ward as the observation group, and 35 patients(?65years) without recent infection to undergo physical examination of our department during the same period as the control group.2. Collected the indexes of the gender, age, body temperature (T), blood pressure (BP),respiratory rate (RR), oxygenation index (PaO2/FiO2),sputum volume and sputum color,consciousness,chest X,serum procalcitonin (PCT),interleukin -6 (IL-6),high sensitive C-reactive protein (hs-CRP),urea nitrogen (BUN),white blood cell (WBC),platelet (PLT),treatment,the basic diseases of the patients and so on. The clinical pulmonary infection score(CPIS) was simplified according to the correlation indexes. Drawed the receiver operating characteristic curve (ROC curve)of the PCT, IL-6, hs-CRP, and CPIS about the observation group and the control group, to analysis the value of PCT, IL-6, hs-CRP, CPIS in the diagnosis of elderly CAP by the ROC curve, to analysis the correlation of the above indexes and the value combined detection in the diagnosis of the aged CAP.3. According to the diagnosis and treatment of guidelines of 2016 Chinese adult community acquired pneumonia about the adult severe CAP diagnostic criteria, the 71 cases of elderly were divided into severe CAP group 27 cases and non severe CAP group 44 cases. The gender, age,hypertension, chronic lung disease history (COPD, chronic bronchitis), simplified CPIS, the level of PCT, IL-6, hs-CRP in serum of the control group was compared with the above two groups.Results:1. Taking the control group and the observation group as the study object, the PCT, IL-6,hs-CRP and simplified CPIS were examined by the normal test. The results showed that the above four indexes were not in the normal distribution. Therefore, the correlation coefficient between the above indexes was analyzed by Spearman correlation coefficient. Correlation analysis showed that PCT, IL-6, hs-CRP and simplified CPIS were positively correlated. There was a highly strong correlation between PCT and simplified CPIS (r = 0.87), and the result was statistically significant (P< 0.001 =0.000). There was a strong correlation between hs-CRP and simplified CPIS (r = 0.75), and the result was statistically significant (P=0.000<0.001). The correlation between the IL-6 and simplified CPIS was moderate intensity, and the result was statistically significant (P<0.05).2. Taking the observation group and the control group as the study object, the ROC curve analysis showed that the AUCs of PCT, IL-6, hs-CRP, and simplified CPIS to diagnose the elderly CAP were (0.920 + 0.025, 0.768 + 0.046, 0.908 + 0.027, 0.978 + 0.010). Therefore, the PCT,hs-CRP and simplified CPIS in the diagnosis of elderly CAP have a higher value, and the result was highly significant (P=0.000<0.001), and its optimal cut-off values were 0.07ng/ml, 22.2mg/L, 1.5,The sensitivities were 83.1%, 83.1% and 85.9%, and their specificities were 94.3%, 82.9% and 91.2%. The IL-6 in serum had a certain value in the diagnosis of CAP about the elderly patients. The best cut-off value is 76.885pg/ml, and its specificity is high (94.3%), but the sensitivity is limited(49.3%). The level of PCT, hs-CRP and simplified CPIS about the elderly CAP patients showed a good positive correlation. The value of three combined diagnoses was highest (AUC 0.990 + 0.006).Its sensitivity was 90.1%, and the specificity was 100%. The results were highly significant(P<0.001).3. There was no significant difference in gender, age and other basic data among the patients of the control group, non severe CAP group and severe CAP group (P>0.05). The patients of non severe CAP compared with the control group, the level of PCT, IL-6, hs-CRP and simplified CPIS scores (0.09 ng/ml (0.06?0.15), 43 pg/ml (21.32?99.85), 43.77mg/L (21.79?83.19), 2.50 (2.00?3.75))were higher than those in the control group (0.04 ng/ml (0.02?0.06), 21.98 pg/ml (9.20?45.47)8.52mg/L (3.89?17.35), 0 (0.00?1.00)), and the results were statistically significant (P<0.05). The patients of severe CAP compared with non severe CAP, the PCT, IL-6, hs-CRP and simplified CPIS score (5.05 ng/ml (1.41 ?23.20),124.57 pg/ml (57.16?254.45),121.85mg/L (78.93?193.53),7(6.00?9.00)) were higher than those in non severe CAP group (0.09 ng/ml (0.06?0.15), 43 pg/ml(21.32?99.85),43.77mg/L (21.79?83.19),2.50 (2.00?3.75)),and the results were statistically significant (P=0.000<0.001). The patients of severe CAP compared with the control group, the level of PCT,IL-6, hs-CRP and simplified CPIS scores (5.05 ng/ml (1.41 ?23.20),124.57 pg/ml(57.16?254.45) were higher than the control group (0.04 ng/ml (0.02?0.06), 21.98 pg/ml(9.20-45.47) 8.52mg/L (3.89?17.35), 0 (0.00?1.00)).Conclusion:1. The level of PCT, hs-CRP, IL-6 in serum and simplified CPIS about the elderly CAP is increased. The PCT, hs-CRP and simplified CPIS with highly diagnostic value, good sensitivity and specificity, could be applied for the diagnosis of the elderly CAP patients.2. The level of PCT, hs-CRP, IL-6 in serum and simplified CPIS about the aged CAP patients can increase with pneumonia severity, which is significantly associated with the progression of the disease. For the elderly CAP, they can provide an important basis for the diagnosis and assessment of the severity of infection.3. Combined detection of serum PCT, hs-CRP level and simplified CPIS has an important clinical significance in early diagnosis and evaluation of CAP in elderly patients.4. The limitation of this study is the small sample size, no observation of dynamic changes of PCT, hs-CRP, and CPIS. In order to obtain a comprehensive and objective conclusion, we will further expand the sample size,refine the scope of the study in later period.