| Objective:To estimate the value of soluble scavenger receptor (sCD163) on early diagnosing and prognosis for stroke associated pneumonia (SAP) patients and evaluating the severity of SAP. To compare the accuracy between sCD163 and other Infection Index such as C-reactive protein (CRP), white blood cell (WBC) and procalcitonin (PCT).Methods:The stroke patients of this prospective study were collected in Intensive Care Unit (ICU) and Emergency Intensive Care Unit (EICU) department in a tertiary hospital from February 2014 to January 2015. According to the guideline, we divided the patients into SAP group and non SAP group, and mild SAP group and severe SAP group. The clinical data were collected, including demographic information (gender, age, etc.), history of stroke, stroke pattern, National Institutes of Health Stroke Scale score (NIHSS), Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ), Clinical Pulmonary Infection Score (CPIS), Pneumonia Severity Index (PSI), temperature, X-ray, oxygenation index, sputum culture, serum levels of sCD163, CRP, WBC, PCT on days 1,3,5,7, length of stay and 28-day mortality. The concentration of sCD163 was detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). ROC and multivariable Logistic analysis were used.Results:1.78 patients were enrolled in the study. Of these patients,44 patients were diagnosed as SAP,34 were non SAP. Of these SAP patients,28 were severe SAP,16 were mild SAP. Compared to the non SAP group, the first day CPIS score, NIHSS score, sCD163 and CRP value and 28-day mortality were all increased in SAP group (P<0.05). Compared to the mild SAP group, the first day CPIS score, NIHSS score, sCD163 value and 28-day mortality were all increased in severe SAP group (P<0.05).2. Compared to the non SAP group, the level of serum sCD163, CRP, WBC and PCT were all higher in SAP group (P<0.05). Compared to the mild SAP group, the level of serum sCD163, CRP, WBC and PCT were all higher in severe SAP group (P<0.05). Compared to the survival group, the level of serum sCD163, CRP, WBC and PCT were all higher in death group (P<0.05).3. SCD163 showed a better capacity for early diagnosing SAP and evaluating the severity of SAP compared to other inflammatory biomarkers. The area under the receiver operating characteristic curve (AUROC) and sensitivity/specificity for the prediction of SAP were 0.814,79.55/85.29% and 0.674,59.09%/76.47%, and the cut-off were 0.545mg/L and 77.72mg/L for sCD163 and CRP respectively. The AUROC and sensitivity/specificity for evaluating the severity of SAP were 0.796,53.57%/100%, 0.676,67.86%/68.75%, and 0.762,57.14%/93.75%, and the cut-off were for 2.41mg/L, 64.1mg/L and 4.5 scores sCD163, CRP and CPIS score respectively. However, the level of PCT and WBC on day 1 has no value for early diagnosing SAP and evaluating the severity of SAP.4. All the risk factors were put in multivariate logistics regression analysis, and the level of sCD163 on day 1, age, NIHSS score, APACHEII score and CPIS score were all proved to be prognostic factors, the odds ratios (OR) were 1.27,1.04,2.86,1.52,2.06 respectively (P<0.05).Conclusion:Firstly, sCD163 may be a useful serum marker on early diagnosing SAP and evaluating the severity, and it was better than CRP, WBC, PCT and CPIS score.Secondly, prognosis of SAP can be evaluated by sCD163. sCD163, age, NIHSS score, APACHEII score and CPIS score are all risk factors for SAP. |
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