| Objective:This study is to quantitatively detect the sputum procalcitonin (PCT) level of adult patients with community-acquired pneumonia (CAP),and the serum PCT and white blood cell count (WBC)and neutrophils percentage (NEUT%) are compared to analyze their diagnostic value for adult bacterial CAP.At the same time,analyze the relationship between sputum PCT and sputum PCT,severity of illness and prognosis,etc.It aims to provide a reference for the application and promotion of sputum PCT quantitative detection in adult CAP.Methods:From October 2019 to January 2021,129 adult CAP patients who were hospitalized in the Department of Respiratory Medicine,Geriatrics,Emergency Department,and Intensive Care Unit (ICU) of the Affiliated Hospital of North Sichuan Medical College were selected as experimental subjects.All selected subjects were tested for sputum PCT quantitatively,and the results of serum PCT,WBC,NEUT% and sputum culture were collected.Collected clinical data on whether the patients had a history of smoking,fever,respiratory failure,severe pneumonia and involvement of pulmonary infection,length of hospital stay,prognosis.The patients were grouped and analyzed according to the following four methods:(1) according to different lung infectious diseases,they were divided into simple CAP group,CAP with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)group,and CAP with bronchiectasis group,CAP with AECOPD and bronchiectasis group,CAP with lung abscess group;(2) according to sputum bacterial culture results,they were divided into sputum bacterial culture positive group and sputum bacterial culture negative group;(3) according to the prognosis,they were divided into a good prognosis group and a poor prognosis group;(4) according to the condition before and after improvement,they were divided into two groups.Analyze and compare the differences in sputum PCT,serum PCT,WBC and NEUT% between the first three conditions,and analyze and observe whether there is dynamic change in sputum PCT before and after the improvement of the patient’s condition.Analyze the correlation between sputum PCT and serum PCT,WBC,NEUT%.Analyze the correlation between sputum PCT and serum PCT and whether the patients had a history of smoking,fever,respiratory failure,severe pneumonia and involvement of pulmonary infection,length of hospital stay,prognosis.Draw ROC curve to analyze the diagnostic value of sputum PCT and other inflammatory markers in adult bacterial CAP.Results:(1) In this study,a total of 129 experimental subjects were included,including 80 males and 49 females,aged (67±16) years old.The median levels of sputum PCT,serum PCT and NEUT% of CAP patients were all higher than normal values to varying degrees.(2) The levels of sputum PCT,WBC and NEUT% of different lung infectious diseases were different,and the difference was statistically significant (P<0.05),while the difference in serum PCT among the five groups was not statistically significant (P>0.05).The sputum PCT level of CAP with AECOPD and bronchiectasis group was the highest,which was 0.56ng/mL (0.33-0.72).(3) The sputum PCT,serum PCT and NEUT% levels of the sputum bacterial culture-positive group were higher than those of the sputum bacterial culture-negative group,and the difference was statistically significant (P<0.05),while the difference in WBC between the two groups was not statistically significan (P>0.05).The sputum PCT level (median was 0.58ng/mL) of the sputum bacterial culture-positive group was significantly higher than serum PCT (median was 0.12ng/mL),and the difference was statistically significant (P<0.05).(4) The levels of serum PCT and NEUT% in the poor prognosis group were higher than those in the good prognosis group,and the difference was statistically significant (P<0.05),while the difference in sputum PCT and WBC between the two groups was not statistically significant (P>0.05).(5) There was no statistically significant difference in the sputum PCT level before and after the improvement of the patient’s condition (P>0.05),and the sputum PCT did not significantly decrease with the improvement of the patient’s anti-infection treatment.(6) Sputum PCT was only correlated with NEUT% (P<0.05),but not correlated with serum PCT and WBC (P>0.05).(7) There was no correlation between sputum PCT and whether the patient had a history of smoking,fever,respiratory failure,severe pneumonia and involvement of pulmonary infection,length of hospital stay,prognosis(P>0.05).Serum PCT had no correlation with whether the patient had a history of smoking,fever,the involvement of lung infection,and the length of hospital stay.It was positively correlated with the patient with respiratory failure and severe pneumonia (P<0.05),and was negatively correlated with the patient’s prognosis (P<0.05).(8) When the cut-off value of sputum PCT was 0.58ng/mL,the diagnostic efficiency of adult bacterial CAP was the best.The sensitivity and specificity were 53.30% and 75.00% respectively,and the AUC was 0.649(P<0.05).When the cut-off value of serum PCT was 0.11 ng/mL,the diagnostic efficiency of adult bacterial CAP was the best.The sensitivity and specificity were 53.30% and 70.20% respectively,and the AUC was 0.619(P<0.05).When NEUT% used 82.35% as the cut-off value,the diagnostic efficiency of adult bacterial CAP was the best.The sensitivity and specificity were 62.20% and 63.10% respectively,and the AUC was 0.617 (P<0.05).Conclusions:(1) Quantitative detection of sputum PCT is helpful for the diagnosis of adult CAP and can be used as an auxiliary diagnostic index.(2) Sputum PCT,serum PCT and NEUT% have a certain diagnostic value for adult bacterial CAP,and sputum PCT has a higher diagnostic value for adult bacterial CAP than serum PCT.(3) Dynamic monitoring of sputum PCT level is of no value in evaluating the changes in the condition of adult CAP patients and the treatment effect,and cannot guide the discontinuation of antibacterial drugs.(4) The sputum PCT level cannot predict the severity and prognosis of adult CAP patients.The serum PCT level is related to the disease and prognosis of adult CAP patients. |
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