The Clinical Significance Of Serum Procalcitonin And High Sensitivity C-reactive Protein Detection In Patients With Pneumonia Complicated With Sepsis

Objective:To assess the clinical significance of serum procalcitonin and high sensitivity C-reactive protein detection in patients with pneumonia complicated with sepsis.Methods:We selected a sample of 190 hospitalized patients with pneumonia from January 2009 to March 2011.According to whether the patients Combined with sepsis and the severity of sepsis, patients were divided into four groups, including 72 cases of non-sepsis,87 cases of mild sepsis,19 cases of severe sepsis, and 12 cases of septic shock. According to the therapeutic effect, patients were divided into two groups, including improvement group and non-improvement group. The differences of serum PCT,hsCRP and APACHEâ…¡scores were compared in different groups. The receiver operating characteristic curve was used to assess the diagnostic value of the PCT, hsCRP and APACHEâ…¡score to predict sepsis,severe sepsis and septic shock and septic shock respectively. Spearman correlation analysis were used to analysis the correlations between PCT, hsCRP and APACHEâ…¡score,PSI score and CURB-65 score respectively.Results:The PCT and hsCRP levels, APACHEâ…¡scores were increased in septic patients compared to non-septic patients and progressively elavated by the severity of sepsis patients. PCT levels and APACHEâ…¡scores were significant different among the non-sepsis group, mild sepsis group, severe sepsis group and septic shock group(P<0.05, respectively).however, hsCRP levels were not significant different among mild sepsis group, severe sepsis group and septic shock group(P>0.05,respectively). For the improvement group, the PCT and hsCRP levels, APACHEâ…¡scores of patients before treatment were significant higher than that after treatment(P<0.01, respectively),however,there were not significant different for the non-improvement group(P>0.05, respectively). The receiver operating characteristic curve for PCT, hsCRP and APACHEâ…¡score to predict pneumonia concurrent sepsis had an area under the curve of 0.842,0.819 and 0.790, respectively.At a PCT cutoff level of 0.5 ng/mL or greater, a hsCRP cutoff level of 45 mg/L or greater and a APACHEâ…¡score cutoff level of 7 points or greater, the sensitivity of the PCT, hsCRP and APACHEâ…¡score for detecting pneumonia concurrent sepsis were71.19%,75.42% and 72.03%, respectively,and the specificity were 95.83%,72.22% and 70.83%, respectively. The receiver operating characteristic curve for PCT, hsCRP and APACHEâ…¡score to predict pneumonia concurrent severe sepsis and septic shock had an area under the curve of 0.876,0.769 and 0.887, respectively. At a PCT cutoff level of 2 ng/mL or greater, a hsCRP cutoff level of 75 mg/L or greater and a APACHEâ…¡score cutoff level of 11 points or greater, the sensitivity of the PCT, hsCRP and APACHEâ…¡score for detecting pneumonia concurrent severe sepsis or septic shock were 61.29%,80.65% and90.32%, respectively,and the specificity were 88.05%,67.92% and 81.76%, respectively. The receiver operating characteristic curve for PCT, hsCRP and APACHEâ…¡score to predict pneumonia concurrent septic shock had an area under the curve of 0.950,0.786 and 0.946, respectively.At a PCT cutoff level of 10 ng/mL or greater, a hsCRP cutoff level of 140 mg/L or greater and a APACHEâ…¡score cutoff level of 15 points or greater,the sensitivity of the PCT, hsCRP and APACHEâ…¡score for detecting pneumonia concurrent septic shock were 58.33%,58.33% and 75.00%, respectively,and the specificity were 96.07%,85.39% and 90.45%, respectively. The PCT levels were positively correlated with APACHEâ…¡score,PSI score and CURB-65 score(r=0.708,0.676,0.713, P<0.01,respectively).The hsCRP levels were also positively correlated with APACHEâ…¡score,PSI score and CURB-65 score(r=0.489,0.414,0.474, P<0.01,respectively).Conclusion:The plasma levels of PCT and hsCRP have significant positive correlation with severity of pneumonia.The PCT levels are more closely correlated with severity score. PCT and hsCRP have the contribution for doctors juding correctly and promptly in the condition of pneumonia concurrent sepsis.To detecting pneumonia concurrent sepsis,the sensitivity of hsCRP is better than that of PCT, however,the specificity of PCT is better than that of hsCRP.The serum level of PCT is superior to serum level of hsCRP in severity classification.