The value of CRP, PCT, LAC and APACHE scores in thediagnosis of sepsis severity
CRP、PCT、LAC与APACHE‖评分对诊断脓毒症严重程度的价值分析

摘要

目的 探讨C反应蛋白（CRP）、降钙素原（PCT）、血乳酸（LAC）指标及急性生理和慢性健康状况评分（APACHEⅡ）对脓毒症患者的诊断以及脓毒症严重程度的价值分析。方法 选取2019年1月至2020年12月在河北省沧州中西医结合医院重症医学病房（ICU）住院的符合Sepsis-3诊断标准的脓毒症患者42例，其中脓毒症休克组18例、严重脓毒症组10例、脓毒症组12例，同期又选取非感染性SIRS组患者19例、非脓毒症感染患者20例作为对照组。统计分析比较各组APACHEⅡ评分、PCT、CRP、LAC的数值，然后应用非条件Logistic逐步回归模型分别对各组进行单因素和多因素的统计分析，绘制受试者工作特征曲线（ROC）曲线并分别比较PCT、LAC、CRP指标及APACHEⅡ评分对于脓毒症患者的诊断价值。结果 单因素的统计分析结果显示各组的年龄、性别比例、体温、白细胞、中性粒细胞比例、中性粒细胞、血小板与脓毒症的诊断及病情严重程度无相关性（P>0.05）；而APACHEⅡ评分、CRP、LAC、PCT与病情程度有相关性（P <0.05）。Logistic逐步回归分析显示PCT、APACHE II、CRP、LAC为诊断脓毒症的独立危险因素（P <0.05），PCT曲线下面积最大。对于不同病情严重程度患者CRP、PCT、LAC及APACHEⅡ评分差异有统计学意义（P<0.05），随着患者病情严重程度增加CRP、PCT、LAC及APACHEⅡ评分明显升高（P<0.05）。PCT、CRP、LAC及APACHEⅡ评分两两互呈显著正相关（P<0.05）。结论 CRP、PCT、LAC及APACHEⅡ评分对脓毒症的诊断以及严重程度的评估具有很高的应用价值。

Abstract

Objective To explore the value of C-reactive protein (CRP), procalcitonin (PCT), blood lactic acid (LAC) and acute physiological and chronic health status score (APACHEⅡ) in the diagnosis of sepsis patients and the analysis of the severity of sepsis.
Methods From January 2019 to December 2020, 42 patients with sepsis who met the diagnostic criteria of Sepsis-3 in ICU of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were selected, including 18 patients in septic shock group, 10 patients in severe sepsis group and 12 patients in sepsis group. In the same period, 19 patients in non-infectious SIRS group and 20 patients with non-septic infection were selected as control group. The values of APACHEⅡ score, PCT, CRP and LAC in each group were statistically analyzed and compared. Then the unconditional Logistic stepwise regression model was used to make single-factor and multi-factor statistical analysis for each group, and the receiver operating characteristic curve (ROC) curve was drawn and the diagnostic values of PCT, LAC, CRP and APACHEⅡ score for sepsis patients were compared respectively.
Results The results of univariate statistical analysis showed that age, sex ratio, body temperature, leukocyte, neutrophil ratio, neutrophil and platelet in each group had no correlation with the diagnosis and severity of sepsis (P > 0.05). APACHEⅡ score, CRP, LAC and PCT were correlated with the severity of the disease (P <0.05). Logistic stepwise regression analysis showed that PCT, APACHE II, CRP and LAC were independent risk factors for the diagnosis of sepsis (P <0.05), and the area under PCT curve was the largest. There were significant differences in the scores of CRP, PCT, LAC and APACHEⅡ among patients with different severity (P<0.05), and the scores of CRP, PCT, LAC and APACHEⅡ increased significantly with the increase of patients' severity (P<0.05). PCT, CRP, LAC and APACHEⅡ ⅱ scores were positively correlated with each other (P<0.05).
Conclusion   CRP, PCT, LAC and APACHEⅡ scores have high application value in the diagnosis of sepsis and the evaluation of its severity.