Clinical Value Of Dynamic Monitoring Of Serum Lactic Acid,D-dimer And Procalcitonin In The Prognosis Of Elderly Patients With Severe Pneumonia

Objective: Adopts the method of retrospective study,to investigate the value of dynamic monitoring blood lactate,D-dimer and procalcitonin(PCT)in evaluating the severity and prognosis of elderly patients with severe pneumonia.Methods: The 82 cases 0f elderly patients with severe pneumonia hospitalized in Department of Respiratory Medicine and ICU in Qianfushan Hospital of Shandong Province from July 2015 to October 2017;All subjects included in this study were strictly screened and accorded the criteria of inclusion and exclusion.The clinical information and data of all subjects were collected.The data including gender,age,Temperature,Blood pressure,basic diseases,blood biochemistry,etc.ALL the patients were recorded the blood lactate,D-dimer and procalcitonin levels on admission,3 days after admission,7 days after admission,and APACHEII scores were also assessed.The level of blood lactic acid was measured again after the treatment of 24 h.According to the difference of the outcome,the patients were divided into survival group and death group.At the same time 24 h lactate clearance rate were calculated and two groups were divided into high and low lactic acid group with 10% threshold.We applied SPSS17.0 statistical software to analyze all dates,and the difference was statistically significant when P<0.05.Results: There was no significant difference in the initial blood lactate level between the survival group and the death group(P>0.05),While the 24 h lactate clearance rate in the survival group(28.17±19.30)mmol/L was significantly higher than that in the death group(17.63±14.23)mmol/L.There was no significant difference in the initial blood lactate levels between the low lactate clearance group(4.80±3.50)mmol/L and the high lactate clearance group(4.50 ±2.52)mmol/L,(t=0.423,(P=0.674<0.05).The mortality of low lactate clearan-ce group was 63.64%,which was significantly higher than that in high lactate clea-rance group.The D-dimer and PCT level was low significantly in survival than th-at in dead group(P<0.05).After treament,the level of D-dimer and PCT were decrease-d gradually in the survival group,while the death group is the opposite.Compared with the death group,the APACHE score of the survival group was lower than that of the death group,there was significant difference between the two group.There was a positive correlation between blood lactate,D-dimer,PCT and APACHEII(t1=0.267,t2=0.346,t3=0.383,P<0.05).Conclusion: 1.The detection of single blood lactate level is of limited value in evaluating the prognosis of elderly patients with severe pneumonia,but the 24 h lactate clearance rate can better reflect the severity of the disease and predict the death situation.;2.The poor prognosis of the elderly patients with severe pneumonia is closely related to the increase of blood lactic acid,D-dimer and PCT after admission.3.The correlation analysis showed that there was a positive correlation between blood lactate,D-dimer,PCT and APACHEII score,and PCT may be of greater value to patients with severe pneumonia.