Prognostic Analysis Of Patients With Ultra-high Level Of Serum Procalcitonin In Intensive Care Unit

?Objective?To explore the prognostic factors of patients with ultra-high level of serum procalcitonin(PCT)in the intensive care unit(ICU),in order to improve clinical outcomes of these patients.?Methods?Ultra-high serum PCT was defined as at least once serum PCT >100ng/ml.After obtaining institutional review board approval,the clinical data of patients with serum PCT>100ng/ml admitted to the ICUs of the First Affiliated Hospital with Nanjing Medical University from December 2016 to November 2017 were collected retrospectively.According to the 28-day prognosis after admission to the ICU,the patients were divided into the survival group and the death group.The clinical data and the laboratory indicators of the day when PCT>100ng/ml in the two groups were compared.Finally,the risk factors affecting the prognosis of these patients were screened out by logistic regression analysis.?Results?A total of 63 ICU patients with serum PCT >100 ng/ml were reviewed.The patient's department was treated as follows: 17 cases of Cardiac macrovascular ICU(27%),15 cases of Emergency ICU(24%),10 cases of Geriatrics ICU(16%),9 cases of Integrated ICU(14%),and 6 cases of General surgery ICU(9%),5 cases(8%)in the Department of Respiratory and Critical Care Medicine,and 1 case(2%)in the Neurosurgery ICU.The main diagnosis of patients: 21 cases(33.3%)after abdominal operation,18 cases(28.6%)of pulmonary infection,17 cases(26.9%)after thoracic surgery,2 cases(3.2%)with multiple injuries,acute non-lymphocytes 1 case of leukemia(1.6%),1 case of biliary tract infection(1.6%),1 case of gastrointestinal infection(1.6%),1 case of cerebral hemorrhage(1.6%),1 case of hemorrhagic fever with renal syndrome(1.6%),One case of viral myocarditis(1.6%).The main causes of PCT elevation wereabdominal infection(21 cases,33.3%),pulmonary infection(18 cases,28.6%),non-infectious Inflammation(14 cases,22.2%)and so on.Compared with the survival group,heart rate,percentage of granulocytes,the use of mechanical ventilation,use of vasoactive drugs,blood lactate level,occurrence of MODS,high SOFA score and APACHEII score on the day onset in the death group were significantly higher than in the survival group,the difference was statistically significant(P<0.05),.and then the multivariate logistic regression analysis was performed for influencing factors with statistically significant differences,and the results showed that APACHEII score was an independent risk factor for poor prognosis in patients with ultra-high serum procalcitonin.?Conclusions?The main departments of patients with ultra-high level of serum PCT in the Department of Critical Care Medicine are ICU,followed by Cardiac macrovascular ICU,Emergency ICU,Geriatrics ICU,Integrated ICU,etc.The ultra-high level of serum PCT patients are mainly diagnosed with abdominal surgery and pulmonary infection.Mainly after thoracic surgery.Infection is the common cause in patients with ultra-high level of serum PCT in ICU,and the site of infection is abdominal cavity,lung and blood flow.Second,other causes such as non-infectious inflammatory reactions should be considered.The prognosis of these patients was closely related to heart rate,percentage of granulocytes,the use of mechanical ventilation,use of vasoactive drugs,blood lactate level,occurrence of MODS,high SOFA score and APACHEII score on the day of onset,and APACHEII score was an independent risk factor influencing the prognosis of these patients.