Dynamic Change Of APACHEⅡ Score And PCT Levels In Patients With Severe Multiple Trauma And Their Clinical Value

ObjectiveTo investigate the dynamic change of APACHE II score and PCT levels in patients with severe multiple trauma and analyze their values in clinical applications.MethodsTotal 35 patients with severe multiple trauma and ISS>16 have been collected from December 2008 to December 2009 in the ICU of my hospital. The blood gas analysis, renal function, ion, CRP, Lactate and PCT levels were measured continuously within one week, and APACHE II score were calculated daily in the patients.All the test items except the PCT were measured by the routine clinical laboratory test, The serum were determined everyday routinely in regular time and delivered to the laboratory center and the results were recorded. Some specimens were collected together to test PCT. The serum PCT were measured by immunoluminometric assay(B·R·A·H·M·S PCT LIA).Patients were divided into two groups:the death group and the survival group according to the final results. The differences between the two groups of the blood gas analysis, renal function,ion, CRP, Lactate and PCT levels were analyzed and the relations between PCT,CRP, Lactate and APACHEⅡscore would also be analyzed.ResultsThe APACHEⅡscore were significantly elevated in death group and the peak value were achieved at the 2th day in survival group, after the 4th day we could see the significant difference between the two groups (p<0.05). The PCT reached peak value and got down quickly to the normal levels in survival group,in death group PCT reached the peak value at the 3th day, after that maintained in a high levels, we could see the remarkable difference between the two groups from the 3th day (p<0.001). CRP reached the peak value at the 4th day in two groups,but got down slowly in survival group, and maintained in a high levels in the two groups, we could see the remarkable difference between the two groups from the 3th day (p<0.001), Lactate reached peak levels at the first day all in two groups,and dropped to the normal level rapidly in survival group and then maintained at normal level, in death group lactate dropped to the normal level at 3th day and elevated again, then maintaining in a high level, the remarkable difference could be determined from 4th day (p<0.05).At the first day the correlated analysis between CRP and APACHE II was negative r=0.367(p>0.05), and lactate had a better correlation than PCT(r=0.745,P<0.001; r=0.423,P<0.05 respectively). In the following time, the correlation between lactate and APACHE II declined, and coefficient r fluctuated about 0.50(P<0.01); the correlation between CRP and APACHE II was bad, the highest value was 0.520(3th day, P＜0.01), in the other time coefficient r value was smaller than 0.50(P<0.05orP<0.01); the correlation between PCT and APACHE II was on the rise, the highest value occurred at 7th day, the coefficient r was 0.734(P<0.001).The lactate and APACHE II had a better correlation in the early time and so as the PCT in the later time, the correlation between CRP and APACHE II was bad totally.ConclusionsDynamic APACHE II score has a better assessment to the severe multiple trauma patients. The correlation between PCT and APACHEⅡis superior than CRP and lactate. PCT can be used as an effective complement to APACHE II score. Continuous measuring of APACHE II score and together with PCT exhibited a strong power for estimate conditions, determining therapeutic interventions, and prediction of outcome.