| Objective:Procalcitonin(PCT)is an important inflammatory indicator for evaluating bacterial infection in recent years.PCT concentration in maintenance hemodialysis(MHD)patients may be related to multiple factors such as PCT excretion disorder,micro-inflammation,calcium and phosphorus metabolism,blood purification,etc.Therefore,the blood PCT level of MHD patients in non-infected state may be higher than that of healthy people.However,there are few studies on the basic blood PCT level of MHD patients(in this paper,the average blood PCT level of MHD patients means excluded from the infected cases in the blood purification center).In patients with end-stage renal disease(ESRD),infection is one of the common complications due to the patient's weakened body resistance,especially bacterial pneumonia,which has a high incidence.There are few reports at home and abroad on the early increase of blood PCT in MHD patients with bacterial pneumonia and the changes of PCT after effective anti-infection treatment.This study through observe the basis of PCT in MHD patients without infection and the change rule of PCT in MHD patients combined with bacterial pneumonia.To explore the early clinical diagnostic value of PCT in MHD patients combined with bacterial pneumonia.To investigate the value of PCT in the early diagnosis of MHD patients with bacterial infection and the changes of blood PCT after effective anti-infection treatment.Methods:1 Subjects:(1)Fifty-one MHD patients hospitalized with bacterial pneumonia in Chengde central hospital from December 2017 to November 2019 were enrolled(including 18 MHD patients hospitalized with bacterial pneumonia in the outpatient department of our hospital).(2)61 of the 122 cases of MHD uncomplicated infection in the outpatient department of our hospital were randomly selected during the same period.(3)50 patients without chronic renal disease or infection were randomly selected from the physical examination center of our hospital.2 Data collection: Demographic information and medical history data of the patients were collected,including age,gender,vital signs,infection site,whether DN caused end-stage renal disease,etc.(1)MHD patient hospitalized with bacterial pneumonia were taken to detect PCT on day 1,3,5 and 14 after admission.At admission,detect blood routine examination,erythrocyte sedimentation rate(ESR),c-reactive protein(CRP),albumin(ALB),triglyceride(TG),total cholesterol(TC),calcium(Ca),phosphorus(P),Parathyroid hormone(PTH),Type B natriuretic peptide(BNP)?pharynx swab,sputum smear,sputum bacteria culture and drug sensitivity test,blood bacteria culture and drug sensitivity test,respiratory virus nine-association,G test,GM test,and sputum acid-fast staining smear were checked.All patients check imaging examination after admission.(2)Patients without MHD infection in outpatient department were taken to detect PCT,blood routine,ESR,CRP,ALB,TG,TC,Ca,P,PTH,BNP,etc.before hemodialysis.(3)Physical examination center of our hospital without chronic kidney disease without infection physical examination fasting blood sampling to determine blood PCT.3 Grouping method: Divide all the subjects into three groups: the infected group,the non-infected group and the physical examination group.The hospitalized MHD patients with bacterial pneumonia were in the infected group(group A),the MHD patients without infection in the outpatient department were in the non-infected group(group B),and those without chronic kidney disease and infection in the physical examination center of our hospital were in the physical examination group(group C).Group A and group B according to whether the cause of end-stage renal disease patients were diabetic nephropathy(DN)are divided into two subgroups.In group A,patients without diabetic nephropathy(N-DN)were in group A1,while those were DN causing ESRD in group A2.In group B,patients without DN were in group B1,while those were DN causing ESRD in group B2.4 Statistical analysis: SPSS 22.0 statistical software was used to analyze the data,the measurement data were expressed as mean ± standard deviation,Independent sample t test was used for comparison between the two groups.?2 test was used for count data.The early diagnostic value of PCT in MHD patients combined with bacterial pneumonia was analyzed by ROC curve.The correlation between PCT level and other inflammatory markers,major nutritional status indicators and anemia indicators was analyzed by Pearson correlation analysis,P<0.05 was considered statistically significant.Results:1 Comparison of general information of included patients1.1 There was no difference in age and gender among patients in group A,group B and group C(P>0.05).There was no difference in age,gender,composition of DM patients,TG,TC,Ca,P,PTH and other laboratory indicators between group A and group B(P>0.05).1.2 All the 51 patients in group A were kept for sputum culture,and 21 patients were returned positive by bacteria,with a positive rate of 41.18%.Among them,37 patients were taken for blood culture during fever,and 5 patients were returned positive by bacteria,with a positive rate of 13.51%.Both sputum culture and blood culture returned positive results in 3 patients,accounting for 5.88% of all MHD patients with pneumonia.2 The basic level of PCT in MHD patientsThe average level of PCT in MHD patients in group B was(0.62±0.39)ng/ml,This result was called the blood PCT basic level of MHD patients in the blood purification center.The average blood PCT level of group C was(0.03±0.11)ng/ml.And the average blood PCT level of group B and group C was tested by independent sample t test.The average blood PCT level of group B was significantly higher than that of group C(t=11.663,P=0.000).It was said that the basic blood PCT level of MHD patients in the blood purification center was significantly higher than that of healthy people.3 The diagnostic value of blood PCT in MHD patients with bacterial pneumonia3.1 The area under the ROC curve of serum PCT at admission was 0.848(95%CI 0.776-0.920),and the concentration of PCT at cut-off value was 0.87ng/ml.At this point,the sensitivity and specificity of blood PCT in diagnosing MHD patients with bacterial pneumonia were 84.3% and 73.8%.3.2 PCT levels in group A were(1.40±0.66)ng/ml,(0.86±0.27)ng/ml,(0.76±0.31)ng/ml,(0.39±0.21)ng/ml on the first,third,fifth and 14 th day after admission.Compared with group B[(0.62±0.39)ng/ml],the result was significant difference(all P<0.05).It was said that,the blood PCT level increased significantly in group A on the first,third and fifth day of admission,and there were significant differences(t=7.408,3.881,2.222,P< 0.05).But showed a significant decline trend after anti-infection treatment,and the blood PCT on the 14 th day of hospitalization was lower than group B,showing a statistical difference(t=-3.854,P<0.05).4 Comparison of other data between the group A and group B: At admission,White blood cell(WBC),Neutrophil(NEUT),CRP and ESR of the patients in group A were significantly higher than that in group B,and there were statistical differences(P<0.05).At admission,the ALB and Hemoglobin(Hb)levels of the two groups were tested by independent sample t test,and the results showed that the ALB and Hb levels of group A were significantly lower than group B,with statistical differences(all P<0.05).5 Correlation analysis: In group A,on the first day of admission,patients' blood PCT was positively correlated with inflammatory indicators WBC,NEUT,ESR and CRP,and the correlation coefficients were(r=0.237,0.293,0.464,0.571,P<0.05).In group B,PCT was negatively correlated with ALB and Hb(r=-0.676,r=-0.427,P< 0.05).The higher the PCT level in MHD patients,the lower the ALB and Hb levels.6 Subgroup analysis was performed in group A and group B according to whether the cause of ESRD was DN: Group A1 compared with group A2,the PCT level of group A1 significantly higher than group A2(t=2.171,P<0.05).Group B1 compared with group B2,there was no significant difference in the basic level of PCT.(t=-0.104,P>0.05).Conclusions:1 The blood PCT base level of MHD patients in this blood purification center was significantly higher than the average level of healthy people's blood PCT.After removing the factors of increased blood PCT base,it was meaningful for the early diagnosis of MHD patients with bacterial pneumonia when the blood PCT level was significantly increased.2 When MHD patients were combined with bacterial pneumonia,the blood PCT showed a significant trend of decline after effective anti-infection treatment.PCT is an accurate index to evaluate the effect of anti-infection treatment.3 After anti-infection treatment,blood PCT was lower than the basic level of blood purification center,suggesting that there is a potential bacterial infection among the factors influencing the micro-inflammatory status of MHD patients. |
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