Study On The Predictive Value Of Prealbumin And C-reactive Protein To Prealbumin Ratio In Community-acquired Pneumonia Complicated With Sepsis

Objective: To investigate the predictive value of prealbumin(PA)and C-reactive protein to prealbumin ratio(CRP/PA)in community-acquired pneumonia(CAP)complicated with sepsis.Method: 373 cases of CAP patients from Shengjing Hospital of China Medical University from January 2015 and June 2020 were selected,all the included patients were in accordance with the "Guidelines for the Diagnosis and Treatment of Adult Community-Acquired Pneumonia in China(2016 Edition)" issued by the Respiratory Society of Chinese Medical Association in 2016.A retrospective to collect information:age,gender,height,weight,basic diseases and other general conditions and vital signs,serum PA,CRP and other laboratory indicators were collected within 24 hours of admission,and CRP/PA were calculated.According to“ the sepsis and septic shock in the third edition international consensus definition”,CAP patients were divided into sepsis group and non-sepsis group.The two groups of collected cases were matched according to age and gender to eliminate the influence of confounding factors of age and gender.Examine the correlation between PA,CRP/PA and community-acquired pneumonia complicated with sepsis.The differences of PA and CRP/PA between the sepsis group and the non-sepsis group were compared,The ROC curve was used to analyze the risk prediction value of PA and CRP/PA in CAP complicated with sepsis.Result: 1.There was a negative correlation between PA and community-acquired pneumonia complicated with sepsis(r=-0.530,P=0.000),and a positive correlation between CRP/PA and community-acquired pneumonia complicated with sepsis(r=0.679,P=0.000).2.The differences of PA and CRP/PA between the sepsis group and the non-sepsis group:(1)PA in sepsis group(0.081(0.060,0.118)g/L)was less than PA in non-sepsis group(0.143(0.108,0.183)g/L);(2)CRP/PA in sepsis group(1.851(1.017,3.086))was more than that in non-sepsis group(0.231(0.082,0.556)),P < 0.05,the difference was statistically significant.3.The risk prediction value of PA and CRP/PA in CAP complicated with sepsis:(1)The area under the ROC curve(AUC)of PA for predicting CAP complicated with sepsis was 0.81(95%CI 0.74-0.87);(2)The area under the ROC curve(AUC)of CRP/PA for predicting CAP complicated with sepsis was0.89(95%CI 0.84-0.94).(3)The optimal critical value of PA was 0.121g/L,the sensitivity was 78.16%,the specificity was 70.12%,the positive predictive value was 72.34%,the negative predictive value was 76.25%,the Yoden index was 0.48.(4)The optimal critical value of CRP/PA was 0.722,the sensitivity was 85.06%,the specificity was 81.61%,the positive predictive value was 82.22%,the negative predictive value was 84.52%,the Yoden index was 0.67.The difference in the diagnostic value of PA and CRP/PA was statistically significant(Z=3.602,P=0.000).Conclusion:Patients with CAP were more likely to complicate with sepsis when PA≤0.121g/L,and CRP/PA ≥0.722,at this time,the sensitivity and specificity of CRP/PA are higher than that of PA.The levels of PA and CRP/PA can reflect the disease progression in patients with CAP and serve as predictors.