| BackgroundVAP was one of the common complications of invasive mechanical ventilation,timely diagnosis and accurate assessment of efficacy were very important for the treatment of VAP.PCT and APACHE? score could be applied to auxiliary diagnosis of infectious diseases and illness condition assessment,had been widely used in clinical work,but for their roles in VAP diagnosis and efficacy assessment were still controversial.Some studies had shown that PCT could be the potential biomarker for VAP diagnosis,but in some studies,PCT had not proved useful for the diagnosis of VAP.As an assessment system,APACHE? score lacked of specificity on the type of diseases.Therefore,we need to further study and find more effective auxiliary diagnostic indicators.HBP was a kind of protein which stored in neutrophils and had the effects of chemotaxis of inflammatory cells,releasing inflammatory mediators,causing inflammation of the body,increasing vascular permeability,and sterilization.But the researches of it on clinical diagnosis and efficacy assessment in VAP were not yet mature.Therefore,we had designed this clinical study to explore the clinical value of diagnosis and efficacy assessment of the HBP,PCT and APACHE? score in VAP.ObjectiveTo explore the clinical value of diagnosis and efficacy assessment of HBP,PCT and APACHE? score in VAP.MethodsA total of 160 patients who required tracheotomy or intubation and assisted breathing with invasive mechanical ventilator in the Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 were selected,and divided into VAP group(n=68 cases)and non-VAP group(n=92 cases)based on whether VAP happened or not,the VAP group was further divided into improvement group and deterioration group based on the curative effect after anti-infection treatment for 1 week.The levels of HBP and PCT in each subject were detected by ELISA and ECLIA respectively,APACHE? score was utilized to assess the severity of illness.The difference between HBP,PCT levels and APACHE? score in differenct groups were compared by statistical analysis and analyzed the relevance within the time of VAP diagnosis.Established the ROC curve,calculated the AUC and found the best cut-off value,analyzed and compared the AUC,sensitivity,specificity,accuracy,positive predictive value and negative predictive value of HBP,PCT,APACHE? score,HBP+PCT,HBP+APACHE?,PCT+ APACHE? and HBP+PCT+APACHE?,analyzed the clinical value of diagnosis and efficacy assessment of them in VAP.Results1.Within the time of initial mechanical ventilation,there were no statistically significant differences in HBP,PCT and APACHE? score between VAP group and non-VAP group(all P>0.05).Within the time of VAP was diagnosed,the levels of HBP,PCT and APACHE? score of VAP group were higher than those within the time of initial mechanical ventilation,were(41.4±21.3 vs 7.3±2.7)?g/L,(0.355±0.254 vs 0.080± 0.038)?g/L and(13.4±2.5 vs 8.4±2.0)score respectively(all P<0.001).The levels of HBP,PCT and APACHE? score had no significant differences between within the time of initial mechanical ventilation and after mechanical ventilation for 1 week in non-VAP group(all P>0.05).2.Within the time of VAP was diagnosed,the linear correlation analysis had shown that HBP was positively correlated with PCT and APACHE? score(r=0.82,0.68,all P<0.001),and PCT was also positively correlated with APACHE? score(r=0.65,P<0.001).3.Compared the improvement group and the deterioration group,within the time of initial mechanical ventilation,there were no statistically significant differences in HBP,PCT and APACHE? score between the improvement group and the deterioration group,(all P>0.05).After anti-infection treatment for 1 week,the levels of HBP,PCT and APACHE? score of the improvement group were lower than those within the time of VAP was diagnosed,were(10.6±3.1vs33.2±16.5)?g/L,(0.115±0.038 vs 0.288±0.203)?g/L and(10.1±1.8 vs 12.7±2.1)score respectively(all P<0.001).Within the time of VAP was diagnosed,the levels of HBP,PCT and APACHE? score of the deterioration group were higher than the improvement group,were(64.0±16.0 vs 33.2±16.5)?g/L,(0.542±0.292 vs 0.115±0.038)?g/L and(15.5± 2.5 vs 12.7±2.1)score respectively(all P<0.001).After anti-infection treatment for 1 week,the levels of HBP,PCT and APACHE? score of the deterioration group were higher than those within the time of VAP was diagnosed,were(85.8±29.4 vs 64.0±16.0)?g/L,(0.851±0.394 vs 0.542±0.292)?g/L and(22.3±1.4 vs 15.5±2.5)score respectively(all P<0.001).4.For the diagnostic and efficacy assessment value of HBP in VAP,the AUC was 0.980 and 0.925 respectively,the sensitivity was 92.6% and 88.9% respectively,the specificity was 92.4% and 78.0% respectively,the accuracy was 92.5% and 82.6% respectively,the positive predictive value was 90.0% and 74.9% respectively,the negative predictive value was 94.4% and 90.5% respectively,were all higher than PCT's and APACHE? score's.5.For the combination of two indicators,for the diagnostic value of VAP,the AUC,sensitivity,specificity,accuracy,positive predictive value and negative predictive value of HBP+APACHE? was 0.981,94.1%,92.4%,94.4%,90.1% and 95.5% respectively,the AUC was essentially the same with PCT+HBP's,was higher than PCT+APACHE?'s.The sensitivity,accuracy and negative predictive value of HBP+APACHE? were higher than PCT+HBP's.For the efficacy assessment value of VAP,the AUC,sensitivity,specificity,accuracy,positive predictive value and negative predictive value of PCT+HBP was 0.944,88.9%,84.0%,86.1%,80.4% and 91.1% respectively,were all higher than HBP+APACHE?'s and PCT+ APACHE?'s.6.For the combination of three indicators,for the diagnostic value of VAP,the AUC,sensitivity,specificity,accuracy,positive predictive value and negative predictive value of HBP+PCT+APACHE?was 0.981,91.2%,95.7%,93.8%,94.0% and 93.6% respectively,the AUC was essentially the same with HBP+APACHE?'s,the specificity and positive predictive value were higher than HBP+APACHE?'s,the difference of sensitivity,accuracy and negative predictive value between them were relatively small.For the efficacy assessment value of VAP,the AUC,sensitivity,specificity,accuracy,positive predictive value and negative predictive value of HBP+PCT+APACHE?was 0.951,94.4%,88.0%,90.7%,85.3% and 95.5% respectively,were all higher than HBP+PCT's.Conclusions1.For the value of diagnosis and efficacy assessment of HBP,PCT and APACHE? score in VAP,HBP may be superior to PCT and APACHE? score.2.The clinical value of diagnosis and efficacy assessment of HBP+PCT+ APACHE? for VAP may be good. |
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