可溶性髓系细胞触发受体-1、降钙素原、脑钠肽联合检测对老年患者重症肺炎预后的评估价值

Value of combined detection of sTREM-1, PCT and BNP in the prognosis evaluation of elderly patients with severe pneumonia

摘要:

目的 探讨血清可溶性髓系细胞触发受体-1（sTREM-1）、降钙素原（PCT）、脑钠肽（BNP）联合检测对老年患者重症肺炎（SP）预后的评估价值。方法 选取2019年2月—2022年1月贵州医科大学附属医院内科重症监护治疗病房（ICU）收治的127例老年SP患者作为研究对象。统计患者入住ICU后28 d的生存情况，并依据是否存活分为生存组和死亡组。对比两组临床资料。多因素Cox回归分析老年SP患者预后的影响因素。制作受试者工作特征（ROC）曲线，以曲线下面积（AUC）评价血清sTREM-1、PCT、BNP及联合检测对老年SP患者预后的评估价值。结果 两组患者性别、年龄、BMI、入住ICU时间、体温、合并基础疾病、吸烟史、饮酒史、机械通气、白细胞计数、白蛋白及血乳酸水平对比，差异无统计学意义（P >0.05）。死亡组病变累及多个肺叶占比和PSI评分、CRP、IL-6、IL-18、sTREM-1、PCT及BNP水平高于生存组（P <0.05）。多因素Cox回归分析结果显示：病变累及多个肺叶［H^R=2.901（95% CI：1.335，6.305）］、PSI评分［H^R=2.807（95% CI：1.024，4.859）］、sTREM-1［H^R=3.370（95% CI：2.659，8.537）］、PCT［H^R=3.155（95% CI：2.054，7.843）］及BNP［H^R=2.998（95% CI：1.786，7.052）］是老年SP患者死亡的危险因素（P <0.05）。ROC曲线分析显示，BNP敏感性最高，为72.22%（95% CI：0.546，0.852），联合检测特异性最高，为95.60%（95% CI：0.885，0.986），联合检测AUC最大，为0.902（95% CI：0.837，0.948）。结论 血清sTREM-1、PCT、BNP联合检测对老年SP患者预后的评估效能较高，可作为临床评估该类患者预后的重要参考指标。

Abstract:

Objective To investigate the prognostic value of combined detection of serum soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), procalcitonin (PCT) and brain natriuretic peptide (BNP) in elderly patients with severe pneumonia (SP).Methods A total of 127 elderly SP patients admitted to the intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from February 2019 to January 2022 were selected. The 28-day survival of elderly SP patients after being admitted to ICU was observed, and they were thus divided into survival group and death group according to their survival status. The clinical data of the survival group and the death group were compared. Multivariable Cox regression analysis was performed to determine factors affecting the prognosis of elderly SP patients. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was used to evaluate the predictive value of serum sTREM-1, PCT, BNP and their combination for the prognosis of elderly SP patients.Results There was no difference in the gender composition, age, body mass index (BMI), time of ICU admission, body temperature, presence of underlying diseases, history of smoking, history of alcohol consumption, mechanical ventilation, white blood cell count, or the levels of albumin and blood lactic acid (P > 0.05). The proportion of multilobar pneumonia, Pneumonia Severity Index (PSI), and the levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-18 (IL-18), sTREM-1, PCT and BNP in the death group were higher than those in the survival group (P < 0.05). Multivariable Cox regression analysis showed that multilobar pneumonia [H^R = 2.901 (95% CI: 1.335, 6.305) ], PSI [H^R = 2.807 (95% CI: 1.024, 4.859) ], sTREM-1 [H^R = 3.370 (95% CI: 2.659, 8.537) ], PCT [H^R = 3.155 (95% CI: 2.054, 7.843) ] and BNP [H^R = 2.998 (95% CI: 1.786, 7.052) ] were factors affecting the death of elderly SP patients (P < 0.05). The results of ROC curve analysis revealed that the sensitivity of BNP, and the specificity and AUC of the combined detection were the highest, with them being 72.22% (95% CI: 0.546, 0.852), 95.60% (95% CI: 0.885, 0.986), and 0.902 (95% CI: 0.837, 0.948), respectively.Conclusions The combination of serum sTREM-1, PCT, and BNP exhibits high efficacy in evaluating the prognosis of elderly SP patients, and can be established as a reference for clinical evaluation of the prognosis of these patients.