The Application Value Of Dynamic Monitoring Serum Procalcitonin On Prognosis Of Severe Pneumonia

Objective:By monitoring the kinetic change of PCT and procalcitonin clearance rate(PCTc),to assess the prognosis value in severe community-acquired pneumonia(SCAP)patients.Methods : Retrospective analysis a total of 173 CAP patients admitted into Fujian Province hospital,60 patients with SCAP and 113 patients with none SCAP.Compare basic information and blood procalcitonin ? C-reactive protein ? D-dimmer patient admission.According to the therapeutic effect,SCAP patients were divided into recovery group and deterioration group.Examining the serum PCT and its clearance rate in 3d?7d and discharged from hospital.By comparison each time PCT and PCTc in two group,whether the differences were statistically significant.Using the receiver operating characteristic curve(ROC)to diagnostic and predictive performance of PCT ?PCTc and D-dimer.Results: In SCAP group,the serum PCT?CRP?D-dimer increased compared with the none SCAP group,the difference were statistically significant(All P<0.05).Patients with diabetes are more likely to develop to SCAP.There were no significant difference in the above indicator between recovery group and deterioration group.With prolonged treatment,PCT was gradually increased or remained at higher level in deterioration group,while in recovery group was gradually decreased,which was significantly lowered at 3days in recovery group compared with that in the deterioration group[0.23(0.06,0.82)vs 0.68(0.21,1.30),Z=-2.514,P=0.012].The area under ROC curve(AUC)of PCT3?PCT7?PCT of discharge predicting the prognosis was 0.694?0.853 ? 0.921,respectively [95% confidence interval(95%CI)was(0.562,0.826),P=0.012;(0.759,0.947),P=0.000;(0.857,0.985),P=0.000].PCTc in deterioration group was lowered which was gradually decreased with development of the disease,while PCTc maintained higher level in recovery group which was gradually increased with improvement of the disease.PCTc at 3,7 days aand when discharge from hospital was significantly higher than that in deterioration group [3d: 20.6(0.00,77.5)% vs-1.7(-160.0,-38.0)%,Z=-2.040,P=0.041;7d: 57.1(0.0,90.8)% vs-21.2(-444.4,-76.3)%,Z=-2.953,P=0.003;discharge: 460.0(0.0,259.0)% vs-14.9(-86.7,136.1)%,Z=-3.370,P=0.001].The AUC of PCTc3?PCTc7 and PCTc of discharge was 0.623?0.788?0.925,respectively [95% confidence interval(95%CI)was(0.480,0.767),P=0.110;(0.676,0.901),P=0.000;(0.861,0.988),P=0.000].As the treatment time,PCT?PCTc on prognosis of SCAP in forecasting accuracy increases.Conclusion:1.The increased levels of PCT were associated with severity of pneumonia.PCT has no obvious advantages in the identification of infection and early prognosis evaluation between CRP?D-dimer.2.Monitoring the dynamic of serum PCT can be better assessed with SCAP and prognosis than initial PCT level.With the condition changes,the PCT level of recovery group declining,but in deterioration group are on rise or at a high level.3.High level of PCT and low level of PCTc,suggesting that poor infection control,deterioration and poor prognosis.At the same time points,PCT and PCTc has the same accuracy of predicting prognosis of SCAP.PCT and PCTc can be as forecasts prognosis indicator of SCAP.