| Objective: To investigate the clinical significance and diagnostic value of procalcitonin level in patients with heart failure complicated with pulmonary infection.Methods: Inclusion criteria: to collected 401 cases retrospectively from our hospital patients during October 2013 to March 2016,including 101 cases of heart failure complicated with pulmonary infection,pure heart failure in 100 cases,only 100 cases of pulmonary infection and 100 cases of normal control group.The etiology of heart failurethe are: coronary heart disease,hypertensive heart disease,dilated cardiomyopathy and valvular heart disease.The serum PCT levels were collected.Exclusion criteria: Patients with cardiogenic shock;the abnormal renal function;acute myocardial infarction,severe trauma and major surgery,severe burns,sustained severe organ perfusion abnormalities,small cell lung cancer C cells,medullary thyroid carcinoma and poisoning.Autoimmune disease and metabolic disease.Diagnostic criteria: Diagnostic criteria for heart failure based on 2012 ESC guidelines for diagnosis and treatment of acute and chronic heart failure;cardiac function classification with reference NYHA classification criteria for heart failure.Guidelines for the diagnosis of lung infection:guidelines for the diagnosis and treatment of community acquired pneumonia in 2013,according to the Chinese Academy of medical sciences.In summary,the diagnosis of simple heart failure and pulmonary infection differently,to meet the above two diagnostic criteria for the diagnosis of heartfailure with pulmonary infection.SPSS 19.0 statistical software was used to sort out the input data.The quantitative data were in accordance with the normal distribution with?x±s,and the analysis of variance was used in the test.Qualitative data use chi-square test.The data were compared with the normal distribution and the differences between groups were compared by rank sum test.The LSD-t method was used in comparisons,P<0.05 was statistically significant.To calculate the P5 of PCT in patients with heart failure complicated with pulmonary infection.The best diagnostic value of PCT in diagnosing heart failure complicated with pulmonary infection was obtained by ROC curve.According to the P5,the best diagnostic value,0.5ng/ml and 2ng/ml,to calculate Se,Sp,PPV and NPV of patients with heart failure complicated with pulmonary infection.Results: Heart failure was higher than that of group PCT group PCT value of heart failure with pulmonary infection(P<0.05)and normal control group PCT(P<0.05);heart failure complicated with pulmonary infection in PCT group there was no significant difference with the simple pulmonary infection group(P>0.05);simple heart failure group PCT value lower than simple pulmonary infection group(P<0.05)but higher than the normal control group(P<0.05);simple pulmonary infection group PCT was higher than the normal control group(P<0.05).Reference value of unilateral PCT in patients with heart failure complicated with pulmonary infection(P5):>0.03ng/ml.Calculation of the 5th percentile(P5)PCT value of 0.03ng/ml,indicating that the value of PCT in patients with more than 95% 0.03ng/ml.According to the ROC curve,when the PCT value was 0.14ng/ml,the maximum area under the curve was 71.9%,and the Youden index was 0.375.The best diagnostic value of PCT in diagnosing pulmonary infection with heart failure was 0.14ng/ml.The best diagnostic value of PCT value of heart failure with pulmonaryinfection was calculated by ROC curve 0.14ng/ml.In 0.03ng/ml,0.14ng/ml,0.5ng/ml,2ng/ml as the boundary value calculation of sensitivity of PCT diagnosis of pulmonary infection in patients with congestive heart failure complicated with pulmonary infection time sensitivity(Se),specificity(Sp),positive predictive value(PPV),negative predictive value(NPV)were as follows:0.03ng/ml sensitivity,specificity,positive predictive value,negative predictive value were 92.1%,21%,54.1%,72.4%;0.14ng/ml sensitivity,specificity,positive predictive value and negative predictive value were 48.5%,86%,77.8%,62.3%;0.5ng/ml sensitivity,specificity,positive predictive value and negative predictive value were 21.8%,95%,81.5%,54.6%;the sensitivity and specificity of 2ng/ml the positive predictive value and negative predictive value were 1%,99%,90.9%,52.1%.Conclusion: 1.the determination of serum PCT has very high sensitivity and specificity in the diagnosis of infectious diseases,and it has a high diagnostic value for the diagnosis of heart failure complicated with pulmonary infection.2.with the 5th percentile,the patients with heart failure with PCT concentration of less than 0.03ng/ml can be excluded from lung infection.3.according to the ROC curve,the best serum PCT concentration in patients with heart failure and pulmonary infection was 0.14ng/ml,which could provide reference value for clinical practice.4.The concentration of PCT in serum of patients with simple heart failure will also increase,so we should pay attention to the identification in the clinical work. |
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