The Value Of Presepsin Combined With Lactate And PSI Score In Diagnosis And Prognosis Of Severe Community Acquired Pneumonia

Objectives:The purpose of this study was to evaluate the diagnosis and prognostic value of soluble CD 14 subtype(sCD14-ST,Presepsin)combinded with lactate and PSI score in patients with Severe Community-Acquired Pneumonia(SCAP).Methods:By using the prospective research methods.the subjects were 35 patients with severe community-acquired pneumonia and 48 patients with community-acquired pneumonia treated in the Department of Respiratory and critical Medicine,Zhengzhou people’s Hospital affiliated to Southern Medical University from November 2019 to September 2020.39 healthy people were included in the control group.Among them,the inclusion criteria of patients with community-acquired pneumonia and severe community-acquired pneumonia refer to the diagnostic criteria in the 2016 edition of the guidelines for the diagnosis and treatment of Communityacquired pneumonia in Chinese Adults.The indexes of each group were compared,and the PSI score was recorded at the same time,ROC was drawn to evaluate the diagnostic efficacy of Presepsin and combined indexes in patients with severe community-acquired pneumonia.According to the 28-day survival outcome of patients with severe community-acquired pneumonia,patients were divided into death group(n=14)and survival group(n=21).The indexes and scores of the two groups were compared and analyzed,and the ROC curve was drawn to evaluate the prognostic value of Presepsin combined with LAC and PSI score in patients with severe community-acquired pneumonia.Results:1、The presepsin level of severe pneumonia group was 805.6(735.6963.2)pg/ml,which was higher than that of non severe pneumonia group 426.2(374.1548.6)pg/ml and healthy control group 131.2(103.7155.4)pg/ml(P<0.05).The scores of PCT,lac and psi in severe pneumonia group,non severe pneumonia group and healthy control group were compared,which were statistically significant(P<0.05).2、In severe pneumonia group,presepsin was positively correlated with PCT,lac and psi(P<0.05).3、The area under the curve of presepsin(AUC=0.892),PCT(AUC=0.8722)and PSI score(AUC=0.869)in the diagnosis of severe pneumonia were higher than that of Lac(AUC=0.792).The AUC of presepsin combined with lac and PSI score in the diagnosis of severe pneumonia was 0.920,the sensitivity was 89.6%,and the specificity was 88.6%.4、The presepsin level of death patients within 28 days in severe pneumonia group was 976.5(783.51147.4)pg/ml,which was significantly higher than that of survival group 743.5(632.9842.3)pg/ml(P<0.05).There were significant differences in PCT,lac levels and PSI scores between the two groups(P<0.05)5、The AUC of presepsin in predicting death within 28 days of severe pneumonia was 0.806.When the cutoff value was 769.8 pg/ml,the sensitivity and specificity were 82.7%and 71.4%,respectively.The AUC of PCT,psi and lac were 0.823,0.777 and 0.813,respectively.The area under ROC curve of presepsin combined with lac and PSI score was 0.880,the sensitivity was 85.7%,and the specificity was 87%.Conclusion:Clinical application of Presepsin,PCT,LAC and PSI score alone has certain reference significance for the diagnosis and prognosis prediction of severe pneumonia,but combined with Presepsin,LAC and PSI score has higher sensitivity and specificity for diagnosis and prognosis evaluation,and has more clinical value.