The Value Of Procalcitonin,Hypersensitive C-reactive Protein And Interleukin-6 In The Diagnosis And Prognosis And Nursing Of Severe Pneumonia

Objective:To evaluate the role of procalcitonin,hypersensitive C-reactive protein and interleukin-6 in the diagnosis and prognosis of severe pneumonia.To investigate an effect nursing strategy for pneumonia patients to reduce the incidence rate of severe pneumonia.Methods:In this study,we investigated the relationship between the changes of PCT,hs-CRP and IL-6 concentration in the blood and the changes of pneumonia,and sought to develop the prognostic index of pneumonia.A total of 108 subjects were enrolled in this study,69 of whom were in the observation group and 39 were in the control group.All 69 patients with CAP were hospitalized in the first affiliated hospital of guangdong pharmaceuticaluniversity from February 2016 to July 2017.The patients in the observation group were healthy volunteers at the same time.According to the admission diagnosis,69 observation groups were divided into the non-severe pneumonia group and the severe pneumonia group.Patients in the control group were healthy volunteers who underwent physical examination at the same time,including 20 males and 19 females,aged 46 to 75 years old,with an average age of 61.26 plus or minus 5.55.According to the diagnostic criteria of community acquired pneumonia and severe pneumonia,69 observation groups were divided into non-severe pneumonia and severe pneumonia group.There were 38 non-severe pneumonia groups,19 males and 19 females,aged52 to 72 years old,and the average age(61.63 plus or minus 5.31).There were 31 cases of severe pneumonia,19 males and 12 females,aged 51 to 72 years old,with an average age of 62.26 plus or minus 4.77.Among the 31 cases of severe pneumonia,11 patients died,with an incidence of 35.48%,and were divided into death group and survival group.Three of the 38 patients with non-severe pneumonia had severe pneumonia,with an incidence of 7.89%.In the observation group,blood samples were collected for blood routine and PCT,IL-6 and hs-CRP before the treatment of antibiotics within four hours on the day of admission.On the 3rd,5th and 7th day of the hospital,the blood samples were collected on the 3rd,5th and 7th,respectively,and the serum PCT,IL-6 and hs-CRP levels were detected.In the control group,blood was extracted from peripheral venous blood,PCT,hs-CRP and IL-6.Using SPSS 21.0 software for statistical analysis,measurement data with the average add and subtract the standard deviation(x ±s),said the observation group and control group age comparing with independent samples t test,the non-severe pneumonia group,the severe pneumonia group and observation group,three groups of age,the WBC,PCT,IL-6,hs-CRP on the first day were using single factor analysis of variance,the non-severe pneumonia group,the severe pneumonia group and observation group,three groups of different time of PCT,IL-6,hs-CRP level were using repetitive measure analysis of variance,count data [n](%)with the number of cases and percentage,said diff between groups by chi-square test,P<0.05 for the difference was statistically significant.Results:1.There was no statistically significant difference in age,gender,smoking history and other general data between non-SCAP group,SCAP group and control group(P>0.05),and the three groups were comparable.The level of white blood cell count in patients with non-SCAP group and SCAP group was higher than that in the control group,and the difference was statistically significant(P<0.05).2.In patients with non-SCAP group and SCAP group,the level of white blood cell count,procalcitonin,hypersensitive C-reactive protein and interleukin-6 in the blood of patients with SCAP group was higher than that in the control group,and the difference was statistically significant(P<0.05).Which SCAP patients PCT in the blood,the hs-CRP,IL-6 levels(10.22 ng/ml,71.78 mg/ml,85.88 pg/ml)were significantly higher than those who continued to SCAP(1.09 ng/ml,24.19 mg/ml,21.51 pg/ml),non SCAP patients PCT in the blood,the hs-CRP,IL-6 levels(1.09 ng/ml,24.19 mg/ml,21.51 pg/ml)were higher than the control group patients(0.47 ng/ml,2.99mg/ml,3.70 pg/ml),the difference had statistical significance(P<0.05).3.With the intervention of clinical treatment,the levels of PCT,hs-CRP and IL-6 in the blood of SCAP and non-scap groups were gradually decreased,and the differences were statistically significant(P<0.05).The levels of PCT,hs-CRP and IL-6 in the blood of patients in the SCAP death group were significantly higher than those in the SCAP survival group,and the difference was statistically significant(P<0.05).With the progress of the treatment,live SCAP patients PCT in the blood,the hs-CRP,IL-6 level gradually decline,the difference was statistically significant(P<0.05),SCAP death patients PCT in the blood,the hs-CRP,IL-6 levels rising,the difference was statistically significant(P<0.05).4.Among the 38 patients with non-severe pneumonia,three patients had severe pneumonia,and the incidence rate was 7.89%.Among the 31 cases of severe pneumonia,11 patients died,and the incidence rate was 7.89%.35.48%.The optimal truncated values in the ROC curves of non-scap and SCAP groups were 2.542 ng/ml,33.950 pg/ml and 54.370 mg/ml;The sensitivity was 82.9%,50.2% and 82.8% respectively,and the specificity was93.8%,94.7% and 84.6.0% respectively.The results were statistically significant(P<0.05).Conclusions:1.The levels of serum PCT,IL-6 and hs-CRP all increased with the severity of pneumonia,and PCT and hs-CRP had better specificity and sensitivity in early diagnosis of severe pneumonia.2.Continuous monitoring of serum PCT,IL-6 and hs-CRP levels can lead to the prognosis of severe pneumonia and guide the clinical use of antibiotics.3.Serum PCT,IL-6 and hs-CRP level can be considered for the diagnosis of severe pneumonia supplementary conditions,the concentration of serum PCT(2.542)ng/ml,concentration of IL-6(33.950)pg/ml and hs-CRP concentration of(54.370)mg/ml to sift through ordinary condition to the early warning value of severe pneumonia in patients with pneumonia.When the serum PCT,IL-6 and hs-CRP levels of patients with pneumonia were close to the early warning values,they were listed as suspects in severe pneumonia.Special nursing measures can be taken to prevent the occurrence of severe pneumonia.