Value of serum procalcitonin and copeptin in predicting prognosis of hospital-acquired pneumo-nia in critically ill patients

Zeng Zong-ding; Xing Chong-hao

doi:10.3969/j.issn.1002-1949.2017.04.013

Abstract：Objective To investigate the prognostic value of serum procalcitonin(PCT)and co-peptin levels in patients with hospital-acquired pneumonia(HAP)in critically ill patients. Methods The third People's Hospital of Hainan province was selected in critically ill patients with hospital-ac-quired pneumonia in 142 cases. The general data and pathogenic bacteria distribution in patients with HAP were recorded, and confirmed by the zeroth day, third day and seventh day respectively to detect the changes of serum PCT and copeptin levels. According to the 28 days survival of HAP, patients were divided into survival group(102 cases)and death group(40 cases), the dynamic changes of serum PCT and copeptin levels were compared between the two groups. Univariate and multivariate logistic regression analysis were used to analyze the prognostic factors of HAP patients, and to draw the ROC curve to evaluate the prognostic value of serum PCT and copeptin levels in patients with HAP. Results A total of 142 HAP patients were isolated from 175 strains of pathogenic bacteria, which were found in Staphylo-coccus aureus, Pseudomonas aeruginosa and Acinetobacter. The death group of age, ICU residence time, CPIS, APACHEⅡand survival group were compared, the difference were statistically significant(P<0.05). The death group third day[(4.62±2.36)ng/mL vs.(0.75±0.63)ng/mL]and seventh day[(6.83± 3.52)ng/mL vs.(0.42±0.27)ng/mL]of serum PCT levels were significantly higher than those in the survival group(P<0.05). The death group on zeroth day[(72.64 ± 12.83)pmol/L vs.(41.63 ± 9.35) pmol/L], third day[(77.45±15.61)pmol/L vs.(36.72±10.67)pmol/L]and seventh day[(84.52±18.47) pmol/L vs.(28.14 ± 8.73)pmol/L]of serum copeptin levels were significantly higher than those in the survival group(P<0.05). Univariate and multivariate Logistic regression analysis showed that PCT and copeptin were independent risk factors for death in patients with HAP, the OR and 95%CI were 1.517 (1.305 to 1.864)and 2.064(1.958 to 3.175), respectively. The ROC curves showed that the critical values of PCTthird days and Copeptinthird days were 46.72 pmol/L and 1.14 ng/mL, respectively. The sensitivity and specificity for predicting the death of HAP patients were 79.5%, 88.6%, 84.2% and 77.3%, respectively. Correlation analysis showed that serum PCT and copeptin levels were positively cor-related(r=0.438, P=0.021;r=0.526, P=0.003;r=0.473, P=0.016). Conclusion Serum PCT and Copeptin levels are independent risk factors for death in patients with HAP. The changes of serum PCT and Copeptin on third day can predict the prognosis of patients with HAP.