降钙素原联合感染可能性评分对肝衰竭患者并发感染的预测价值

刘文慧; 甘建和; 秦爱兰

doi:10.3969/j.issn.1001-5256.2019.09.022

降钙素原联合感染可能性评分对肝衰竭患者并发感染的预测价值

DOI: 10.3969/j.issn.1001-5256.2019.09.022

苏州大学附属第一医院感染科

基金项目:

“十三五”国家科技重大专项项目(2017ZX10203201002-002)；

详细信息

中图分类号: R575.3
计量
- 文章访问数: 899
- HTML全文浏览量: 45
- PDF下载量: 236
- 被引次数: 0
出版历程
- 收稿日期: 2019-05-15
- 出版日期: 2019-09-20

Value of procalcitonin combined with Infection Probability Score in predicting infection in patients with liver failure

Department of Infectious Diseases, The First Hospital Affiliated to Soochow University

Research funding:

摘要

摘要:
目的评价降钙素原（PCT）联合感染可能性评分（IPS）对肝衰竭患者并发感染可能性的预测作用。方法回顾性分析2015年1月-2018年6月苏州大学附属第一医院收治的肝衰竭患者的临床资料,根据临床诊断将其分为感染组和非感染组。比较2组患者临床特征、常见的实验室指标以及IPS评分、序贯器官衰竭估计（SOFA）评分。计量资料2组间比较采用t检验或Wilcoxon秩和检验;计数资料2组间比较采用χ2检验。采用多因素logistic回归分析感染发生的影响因素,并建立PCT联合IPS评分诊断模型,利用受试者工作特征曲线（ROC曲线）分析PCT联合IPS评分对患者发生感染的预测效能。结果最终纳入179例肝衰竭患者,并发感染者123例（68. 72%）,其中肺部感染99例（80. 49%）、腹腔感染49例（39. 84%）,合并2个及以上部位感染40例（32. 52%）。多因素logistic回归分析显示PCT[比值比（OR）=3. 822,95%可信区间（95%CI）:1. 714～8. 523,P=0. 001]和IPS评分（OR=1. 125,95%CI:1. 030～1. 230,P=0. 00...
- 肝功能衰竭 /
- 感染 /
- 降钙素原 /
- 感染可能性评分
Abstract:
Objective To investigate the value of procalcitonin ( PCT) combined with Infection Probability Score ( IPS) in predicting the possibility of infection in patients with liver failure. Methods A retrospective analysis was performed for the clinical data of patients with liver failure who were admitted to The First Hospital Affiliated to Soochow University from January 2015 to June 2018. According to the clinical diagnosis, the patients were divided into infection group and non-infection group, and the two groups were compared in terms of clinical features, common laboratory markers, IPS score, and sequential organ failure assessment ( SOFA) score. The t-test and the Wilcoxon rank-sum test were used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was performed to analyze the influencing factors for infection and establish a diagnostic model of PCT combined with IPS score. The receiver operating characteristic ( ROC) curve was used to assess the predictive efficiency of PCT combined with IPS score in infection. Results A total of 179 patients with liver failure were enrolled, among whom 123 ( 68. 72%) experienced infection. Among the 123 patients with infection, 99 ( 80. 49%) had pulmonary infection, 49 ( 39. 84%) had abdominal infection, and 40 ( 32. 52%) had infections at 2 or more sites. The multivariate logistic regression analysis showed that PCT ( odds ratio [OR]= 3. 822, 95% confidence interval [CI]: 1. 714-8. 523, P = 0. 001) and IPS score ( OR = 1. 125, 95% CI: 1. 030-1. 230, P = 0. 009) were independent predictive factors for liver failure with infection. The ROC curve analysis showed that PCT combined with IPS score had the strongest predictive efficiency in liver failure with infection with an area under the ROC curve ( AUC) of 0. 857 ( 95% CI:79. 7-90. 5) , with a significantly higher predictive efficiency than IPS alone and PCT alone ( 0. 857 vs 0. 803/0. 802, both P < 0. 05) , and PCT combined with IPS score had a positive likelihood ratio as high as 3. 40 and a negative likelihood ratio as low as 0. 28. Conclusion Both PCT and IPS score can predict infection in patients with liver failure with similar predictive efficiency, while a combination of PCT and IPS score has a better predictive value.
- liver failure /
- infection /
- procalcitonin /
- infection probability score

HTML全文

参考文献(19)

[1] PERES BD, MLOT C, LOPES FF, et al. Infection Probability Score (IPS) :A method to help assess the probability of infection in critically ill patients[J]. Crit Care Med, 2003, 31 (11) :2579-2584.

[2] KENZAKA T, OKAYAMA M, KUROKI S, et al. Use of a semiquantitative procalcitonin kit for evaluating severity and predicting mortality in patients withsepsis[J]. Int J Gen Med, 2012, 5:483-488.

[3] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association. Diagnostic and treatment guidelines for liver failure (2018 version) [J]. J Clin Hepatol, 2019, 35 (1) :38-44. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2018年版) [J].临床肝胆病杂志, 2019, 35 (1) :38-44.

[4] Chinese Society of Hepatology, Chinese Medical Association.Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33 (10) :1847-1863. (in Chinese) 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志, 2017, 33 (10) :1847-1863.

[5] QU JM, CAO B. Guidelines for the diagnosis and treatment of adult community acquired pneumonia in China (2016 Edition) [J]. Chin J Tuberc Respir Dis, 2016, 39 (4) :241-242. (in Chinese) 瞿介明, 曹彬.中国成人社区获得性肺炎诊断和治疗指南 (2016年版) 修订要点[J].中华结核和呼吸杂志, 2016, 39 (4) :241-242.

[6] Infections Group, Chinese Society of Respiratory Diseases, Chinese Medical Association. Guidelines for the diagnosis and treatment of acquired pneumonia and ventilator-associated pneumonia in Chinese adult hospitals (2018 edition) [J]. Chin J Tuberc Respir Dis, 2018, 41 (4) :255-280. (in Chinese) 中华医学会呼吸病学分会感染学组.中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南 (2018年版) [J].中华结核和呼吸杂志, 2018, 41 (4) :255-280.

[7] ZHU B, OUYANG C, LIU HL, et al. Clinical value of procalcitonin and C-reactive protein test in HBV-related liver failure patients[J]. Chin J Exp Clin Virol, 2014, 28 (2) :93-95. (in Chinese) 朱冰, 欧阳灿, 刘鸿凌, 等. C反应蛋白和降钙素原检测在乙肝肝衰竭患者中应用的临床意义[J].中华实验和临床病毒学杂志, 2014, 28 (2) :93-95.

[8] Chinese Expert Consensus Writing Group for diagnosis and treatment of urinary tract infection. Chinese expert consensus on diagnosis and treatment of urinary tract infection (2015 edition) -complex urinary tract infection[J]. Chin J Urol, 2015, 36 (4) :241-244. (in Chinese) 尿路感染诊断与治疗中国专家共识编写组.尿路感染诊断与治疗中国专家共识 (2015版) ———复杂性尿路感染[J].中华泌尿外科杂志, 2015, 36 (4) :241-244.

[9] WANG YJ. Liver failure related bacterial infection and antimicrobial treatment[J]. J Prac Hepatol, 2014, 17 (2) :117-120. (in Chinese) 王英杰.肝衰竭并发细菌感染与抗生素治疗[J].实用肝脏病杂志, 2014, 17 (2) :117-120.

[10] ZIDER AD, ZOPEY R, GARG R, et al. Prognostic significance of infections critically ill adult patients with acute liver injury:A retrospective cohort study[J]. Liver Int, 2016, 36 (8) :1143-1150.

[11] ZANG H, LIU HL, HAO YQ, et al. Risk factors for infections in patients with acute-on-chronic liver failure and their influences on short-term outcome[J]. Infect Dis Info, 2015, 28 (5) :288-292. (in Chinese) 臧红, 刘鸿凌, 郝玉清, 等.慢加急性肝衰竭并发感染的危险因素及对近期预后的影响[J].传染病信息, 2015, 28 (5) :288-292.

[12] HU SY, CHEN YW, PAN ZQ, et al. Risk factors of liver failurerelated hospital infection in China:A meta-analysis[J]. J Zunyi Med Univ, 2014, 37 (5) :520-528. (in Chinese) 胡世芸, 陈妍雯, 潘宗琴, 等.我国肝衰竭医院感染危险因素的Meta分析[J].遵义医学院学报, 2014, 37 (5) :520-528.

[13] NASIMFAR A, SADEGHI E, KARAMYYAR M, et al. Comparison of serum procalcitonin level with erythrocytes sedimentation rate, C-reactive protein, white blood cell count, and blood culture in the diagnosis of bacterial infections in patients hospitalized in Motahhari hospital of Urmia (2016) [J]. J Adv Pharm Technol Res, 2018, 9 (4) :147-152.

[14] HUANG WG. Value of procalcitonin in the diagnosis of severe infection[J]. J Inter Intens Med, 2017, 23 (3) :237-239. (in Chinese) 黄维国.血清降钙素原诊断危重感染临床分析[J].内科急危重症杂志, 2017, 23 (3) :237-239.

[15] QIN YQ, WEI ZW, LI F. Diagnostic value of serum procalcitonin detection for secondary infection of liver failure[J]. Prac J Med Pharm, 2017, 34 (12) :1093-1095. (in Chinese) 覃亚勤, 韦贞伟, 李芬.血清降钙素原检测对肝衰竭继发性感染的诊断价值[J].实用医药杂志, 2017, 34 (12) :1093-1095.

[16] MARTINI A, GOTTIN L, MLOT C, et al. A prospective evaluation of the Infection Probability Score (IPS) in the intensive care unit[J]. J Infect, 2008, 56 (5) :313-318

[17] ZHU CH, LUO SY. Infection probability score to monitor the value of nosocomial bloodstream infection in patients with multiple myeloma[J]. Chin J Gerontol, 2017, 37 (19) :4872-4873. (in Chinese) 朱春华, 罗世玉.感染可能性评分监测多发性骨髓瘤患者院内血流感染的价值[J].中国老年学杂志, 2017, 37 (19) :4872-4873.

[18] DONG R, WAN B, LIN S, et al. Procalcitonin and liver disease:A literature review[J]. J Clin Transl Hepatol, 2018, 7 (1) :51-55.

[19] QU J, FENG P, LUO Y, et al. Impact of hepatic function on serum procalcitonin for the diagnosis of bacterial infections in patients with chronic liver disease:A retrospective analysis of324 cases[J]. Medicine (Baltimore) , 2016, 95 (30) :e4270.

施引文献

资源附件(0)

访问统计