Dynamic changes of actived protein C, brain natriuretic peptide and acute physiology andchronic health evaluation Ⅱ score in senile severe pneumonia patients and the relationships with prognosis

doi:10.3877/cma.j.issn.1674-1358.2020.02.013

Abstract

Abstract:

Objective

To investigate the dynamic changes of activated protein C (APC), brain natriuretic peptide (BNP), acute physiology and chronic health status scoring system Ⅱ (APACHE Ⅱ) in elderly patients with severe pneumonia, and to analyze their relationship with the prognosis.

Methods

Total of 288 elderly patients with severe pneumonia who were treated in Chengdu West District Hospital from June 2016 to June 2018 were selected. They were divided into survival group (168 cases) and death group (120 cases) according to 28-day survival condition. The levels of serum APC and BNP of each group werer detected by chemiluminescence and enzyme-linked immunosorbent assay, respectively; and the status of each group were evaluated by APACHE Ⅱ score. The dynamic changes of APC, BNP and APACHE Ⅱ scores in each group at the first day, the fourth day and the seventh day were compared between the two groups, respectively. The risk factors of senile severe pneumonia were explored by Logistic regression analysis, and the value of the combined three indexes in predicting the prognosis of senile severe pneumonia was analyzed by ROC curve analysis.

Results

Compared with the death group, the levels of BNP [(494.62 ± 34.82) pg/ml, (318.42 ± 27.42) pg/ml and (274.61 ± 20.84) pg/ml] and APACHE Ⅱ score [(24.05 ± 4.82), (18.62 ± 3.71) and (12.13 ± 2.62)] of cases in survival group significantly increased at the first day, the fourth day and the seventh day, with significant differences (all P < 0.001), but the levels of APC [(289.34 ± 18.39) ng/ml, (357.64 ±32.71) ng/ml and (427.25 ± 18.45) ng/ml] decreased, with significant differences (t = 5.512, 35.499, 78.552; all P < 0.001). The BNP level and APACHE Ⅱ score of cases in survival group decreased with the extension of hospitalization time (F = 24.538, P < 0.001; F = 12.945, P < 0.001), while the level of APC increased gradually (F = 23.947, P < 0.001). In the death group, with the extension of hospitalization time, the levels of BNP and APACHE Ⅱ score increased gradually (F = 15.302, P < 0.001; F = 10.389, P < 0.001); while the levels of APC decreased gradually, with significant difference (F = 34.165, P < 0.001). There were significant differences in smoking history [36.90% (62/168) vs. 53.33 (64/120)], chronic respiratory disease history [46.43 (78/168) vs. 65.83 (79/120)], partial oxygen pressure [(83.27 ± 6.92) mmHg vs. (76.82 ± 8.65) mmHg] and mechanical ventilation [35.12 (59/168) vs. 52.50 (63/120)] between cases in survival group and death group (χ² = 7.677, P = 0.006; χ² = 10.630, P = 0.001; t = 9.881, P < 0.001; χ² = 8.661, P = 0.003). Logistic regression analysis showed that mechanical ventilation (OR = 4.627, P < 0.001), APC (OR = 2.637, P = 0.012), BNP (OR = 3.325, P = 0.005) and APACHEE Ⅱ scores (OR = 4.831, P < 0.001) were all independent risk factors of senile severe pneumonia. Compared with the single prediction of APC, BNP and APACHE Ⅱ scores, the sensitivity, specificity, positive predictive value and negative predictive value of the combined prediction of severe pneumonia death in the elderly were significantly increased (89.42%, 81.61%, 84.72% and 86.03%).

Conclusions

APC, BNP and APACHEE Ⅱ scores change significantly in the progression of senile severe pneumonia, and were independent risk factors of senile severe pneumonia. The combination of the three indexes could significantly improve the prognostic predictive value.

Key words: Senile severe pneumonia, Actived protein C, Brain natriuretic peptide Acute physiology andchronic health evaluation Ⅱ, Dynamic change, Prognosis

Yan Zhang, Xiaoling Wen. Dynamic changes of actived protein C, brain natriuretic peptide and acute physiology andchronic health evaluation Ⅱ score in senile severe pneumonia patients and the relationships with prognosis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(02): 157-162.

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References 25

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指标		生存组（168例）	死亡组（120例）	t值	P值
APC（ng/ml）		?	?	?	?
?	第1天	289.34 ± 18.39	276.23 ± 21.84	5.512	< 0.001
?	第4天	357.64 ± 32.71	226.38 ± 28.26	35.499	< 0.001
?	第7天	427.25 ± 18.45	183.43 ± 33.81	78.552	< 0.001
?	F值	23.947	27.182	34.165	?
?	P值	< 0.001	< 0.001	< 0.001	?
BNP（pg/ml）		?	?	?	?
?	第1天	494.62 ± 34.82	749.14 ± 42.92	55.457	< 0.001
?	第4天	318.42 ± 27.42	814.62 ± 50.47	107.232	< 0.001
?	第7天	274.61 ± 20.84	904.25 ± 57.15	131.184	< 0.001
?	F值	24.538	15.302	28.839	?
?	P值	< 0.001	< 0.001	< 0.001	?
APACHE Ⅱ		?	?	?	?
?	第1天	24.05 ± 4.82	28.34 ± 5.17	7.224	< 0.001
?	第4天	18.62 ± 3.71	34.51 ± 6.35	26.688	< 0.001
?	第7天	12.13 ± 2.62	39.55 ± 7.32	44.732	< 0.001
?	F值	12.945	10.389	16.381	?
?	P值	< 0.001	< 0.001	< 0.001	?

指标		生存组（168例）	死亡组（120例）	t值	P值
APC（ng/ml）		?	?	?	?
?	第1天	289.34 ± 18.39	276.23 ± 21.84	5.512	< 0.001
?	第4天	357.64 ± 32.71	226.38 ± 28.26	35.499	< 0.001
?	第7天	427.25 ± 18.45	183.43 ± 33.81	78.552	< 0.001
?	F值	23.947	27.182	34.165	?
?	P值	< 0.001	< 0.001	< 0.001	?
BNP（pg/ml）		?	?	?	?
?	第1天	494.62 ± 34.82	749.14 ± 42.92	55.457	< 0.001
?	第4天	318.42 ± 27.42	814.62 ± 50.47	107.232	< 0.001
?	第7天	274.61 ± 20.84	904.25 ± 57.15	131.184	< 0.001
?	F值	24.538	15.302	28.839	?
?	P值	< 0.001	< 0.001	< 0.001	?
APACHE Ⅱ		?	?	?	?
?	第1天	24.05 ± 4.82	28.34 ± 5.17	7.224	< 0.001
?	第4天	18.62 ± 3.71	34.51 ± 6.35	26.688	< 0.001
?	第7天	12.13 ± 2.62	39.55 ± 7.32	44.732	< 0.001
?	F值	12.945	10.389	16.381	?
?	P值	< 0.001	< 0.001	< 0.001	?

临床资料		生存组（168例）	死亡组（120例）	统计量	P值
性别[例（%）]		?	?	χ² = 2.554	0.110
?	男	92（54.76）	77（64.16）	?	?
?	女	76（45.24）	43（35.84）	?	?
平均年龄（±s，岁）		68.34 ± 6.81	69.17 ± 7.05	t = 1.005	0.136
糖尿病病史[例（%）]		?	?	χ² = 0.771	0.380
?	是	85（50.60）	67（55.83）	?	?
?	否	83（49.40）	53（44.17）	?	?
高血压病史[例（%）]		?	?	χ² = 1.478	0.224
?	是	76（45.24）	63（52.50）	?	?
?	否	92（54.76）	57（47.50）	?	?
吸烟史[例（%）]		?	?	χ² = 7.677	0.006
?	是	62（36.90）	64（53.33）	?	?
?	否	106（63.10）	56（46.67）	?	?
慢性呼吸系统病史[例（%）]		?	?	χ² = 10.630	0.001
?	是	78（46.43）	79（65.83）	?	?
?	否	90（53.57）	41（34.17）	?	?
氧分压（±s，mmHg）		83.27 ± 6.92	76.82 ± 8.65	t = 9.881	< 0.001
二氧化碳分压（±s，mmHg）		36.54 ± 3.62	37.12 ± 4.02	t = 1.819	0.069
是否机械通气[例（%）]		?	?	χ² = 8.661	0.003
?	是	59（35.12）	63（52.50）	?	?
?	否	109（64.88）	57（47.50）	?	?

临床资料		生存组（168例）	死亡组（120例）	统计量	P值
性别[例（%）]		?	?	χ² = 2.554	0.110
?	男	92（54.76）	77（64.16）	?	?
?	女	76（45.24）	43（35.84）	?	?
平均年龄（±s，岁）		68.34 ± 6.81	69.17 ± 7.05	t = 1.005	0.136
糖尿病病史[例（%）]		?	?	χ² = 0.771	0.380
?	是	85（50.60）	67（55.83）	?	?
?	否	83（49.40）	53（44.17）	?	?
高血压病史[例（%）]		?	?	χ² = 1.478	0.224
?	是	76（45.24）	63（52.50）	?	?
?	否	92（54.76）	57（47.50）	?	?
吸烟史[例（%）]		?	?	χ² = 7.677	0.006
?	是	62（36.90）	64（53.33）	?	?
?	否	106（63.10）	56（46.67）	?	?
慢性呼吸系统病史[例（%）]		?	?	χ² = 10.630	0.001
?	是	78（46.43）	79（65.83）	?	?
?	否	90（53.57）	41（34.17）	?	?
氧分压（±s，mmHg）		83.27 ± 6.92	76.82 ± 8.65	t = 9.881	< 0.001
二氧化碳分压（±s，mmHg）		36.54 ± 3.62	37.12 ± 4.02	t = 1.819	0.069
是否机械通气[例（%）]		?	?	χ² = 8.661	0.003
?	是	59（35.12）	63（52.50）	?	?
?	否	109（64.88）	57（47.50）	?	?

影响因素	β值	SE值	Wald值	OR值	95%CI	P值
行机械通气	1.035	0.682	8.936	4.627	3.034～6.391	< 0.001
APC	0.692	0.386	7.621	2.637	1.582～4.036	0.012
BNP	0.594	0.236	6.553	3.325	2.116～5.032	0.005
APACHE Ⅱ评分	1.236	0.592	9.034	4.831	3.227～6.394	< 0.001

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