The Clinical Research Of Dynamic Monitoring C-reactive Protein Used To Access The Curative Effect And Prognosis Of Severe Community-acquired Pneumonia

Objective To explore the value of dynamic monitoring C-reactive protein(CRP, C-reactive protein) that was used to assess the curative effect and prognosis of severe community-acquired pneumonia.Methods 1.From 2012 June to 2014 March, 60 patients admitted in the intensive care unit of Xian Shuigu hospital were collected who were more than 18 year old patients with severe community acquired pneumonia. The data of the patients were retrospectively analyzed. After the patients were admitted in ICU, anti-infective drugs were used within an hour. Before anti-infective drugs were used, blood samples of CRP, white blood cells(WBC), procalcitonin(PCT) and etiology specimens were returned. The day of ICU admission was defined as D0, and the following days were successively defined as D1,D2,…,D7. From D0 to D7,blood CRP value, white blood cells(WBC) and procalcitonin(PCT) were daily monitored, and Sequential Organ Failure Assessment(SOFA) scores were daily calculated in each person. On the day of ICU admission and on the every morning from D1 to D7,all blood samples were got from the same artery catheter. Calculation of D1,D2,…,D7 CRP value divided by D0 CRP value was defined as C-reactive protein ratio(CRP-ratio). The changes between the value of C-reactive protein of the daily and the day before were calculated,and were called △CRP, the drops with positive expressed, the increases with negative expressed. Calculation of △CRP divided by C-reactive protein values of the day before was defined as C-reactive protein rate(CRP- rate), and the above indexes were record item by item. According to the CRP-ratio response to anti-infective drugs, the patients were divided into three groups: Quick response groups: D4CRP-ratio <0.4; Slow response groups: 0.4≤D4CRP-ratio < 0.8; No response groups: D4CRP-ratio≥0.8. Basis in discharge end the patients were divided into survival group and death group, and the changes of above indexes were analyzed by statistics,and the conclusion was obtained. 2.CRP level was measured by immune turbidimetry, PCT level was measured by double antibody sandwich method.3.Statistical analysis:SPSS19.0 software was used for statistical analysis.The non-normal distribution data was expressed as median(M). Mann-Whitney U test was used when two independent samples was non-normal distribution and the normal distribution data was expressed as mean±SD. Comparisons between groups were performed by using the unpaired and paired t test when the sample and the mean were normal distribution.Analysis of variance(ANOVA) was used for the comparison of two or more sample mean,and the chi-squared(x2) test was used for categorical variables. A multivariate logistic regression analysis was used to identify the risk factors of mortality. Spearman rank correlation was used to access correlation between variables. ROC curves were drawn and the cut-off point was concluded when the value of Youden index was the largest, and areas under the curves were compared. All statistics were two-tailed, and a P value of less than 0.05 was statistically significant.Results 1. From day 1 to day 7, time-dependent analysis of the CRP- ratio in survivors showed a more steady decrease than that in non-survivors,and starting from the D3,the differences of the CRP- ratio between survivors and non-survivors were significant, The area under the curve(AUC) of D3 CRP-ratio was 0.711(95%CI= 0.567-0.854), D3 CRP-ratio > 0.55 was a sign of poor curative effect and prognosis. 2. The CRP-ratio on the third day positively correlated with the PCT level,the SOFA score(r = 0.289, P = 0.018; r = 0.400, P = 0.001). The logistic regression analysis showed the CRP-ratio and PCT level and SOFA on the third day were independent risk factors for mortality. 3. The comparison between the area under the receiver operating characteristic curve of D3 CRP-ratio and those of PCT, SOFA score, the white blood cells at this point, the former three had good prediction ability, and D3 CRP-ratio had higher sensitivity. 4. According to the CRP-ratio response to anti-infective drugs, the patients were divided into three groups.the CRP-ratio, PCT and SOFA score respectively were at different levels in three groups, and the differences were obvious(P < 0.05). 5.The area under the ROC of the largest CRP-rate was 0.865(95% CI = 0.7570.974); CRP-rate≥0.25 was the mark of a effective treatment and a good prognosis.Conclusions 1. The level of D3 CRP-ratio could reflect severity of severe community-acquired pneumonia, the higher the level of D3 CRP-ratio was, the severer the patient’s condition was. 2. The dynamic monitoring of blood CRP in guiding anti-infective drugs application had a certain value;According to the CRP-ratio response to anti-infective drugs, the patients were divided into different groups,which could provide risks stratification for patients with severe community-acquired pneumonia,and was useful to evaluate the treatment effect and prognosis,and could provide the evidence for adjusting the treatment plan and individualized treatment plan. 3. The dynamic monitoring of blood CRP was helpful to evaluate the curative effect and prognosis of severe community-acquired pneumonia. Early dynamic monitoring of blood CRP-rate could be used to evaluate the curative effect and prognosis of severe community-acquired pneumonia; To calculate CRP –ratio could be as early in the third day after anti-infection treatment used to evaluate the treatment effect and prognosis, which had higher sensibility than the PCT and SOFA score.