Value of 6-hour lactate clearance rate combined with NT-proBNP and albumin detection in prognostic evaluation of elderly patients with severe pneumonia

doi:10.3877/cma.j.issn.1674-0785.2021.12.008

Abstract

Abstract:

Objective

To evaluate the value of 6-hour lactate clearance combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) and albumin (ALB) in the prognostic evaluation of elderly patients with severe pneumonia.

Methods

A retrospective analysis was performed on 110 elderly patients with severe pneumonia admitted to the intensive care unit (ICU) of Beijing Electric Power Hospital from September 2018 to September 2020. According to the 28-day prognosis, the patients were divided into either a survival group (62 cases) or a death group (48 cases). Blood lactic acid levels of the subjects were collected, and the 6-hour lactic acid clearance rate was calculated. Enzyme-linked immunosorbent assay (ELISA) was used to detect the level of serum NT-proBNP in subjects, and bromocresol green method was used to detect the level of serum ALB in subjects. Binary logistic regression was used to analyze the influencing factors of death in elderly patients with severe pneumonia. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of 6-hour lactate clearance rate, serum NT-proBNP, and ALB for the death of elderly patients with severe pneumonia.

Results

Compared with the survival group, the 6-hour lactic acid clearance rate and serum ALB level significantly decreased in the death group (P＜0.05), and the serum NT-proBNP level significantly increased (P＜0.05). Binary logistic regression analysis showed that the 6-hour lactate clearance rate (OR=2.035, 95%CI: 1.511~2.741), low serum ALB level (OR=2.132, 95%CI: 1.662~2.735), and high serum NT-proBNP level (OR=2.671, 95%CI: 2.182~3.493) were risk factors for death in elderly patients with severe pneumonia (P＜0.05 each). ROC analysis showed that the area under the ROC curve (AUC) of 6-hour lactate clearance for predicting death was 0.789 (95%CI: 0.703~0.874), and the AUCs of serum NT-proBNP and serum ALB were 0.762 (95%CI: 0.671~0.853) and 0.726 (95%CI: 0.628~0.825), respectively. The AUC of combined detection of 6-hour lactate clearance with serum NT-proBNP and ALB was 0.900 (95%CI: 0.843~0.957).

Conclusion

In elderly patients with severe pneumonia, the 6-hour lactate clearance rate and serum ALB level decrease and serum NT-proBNP level increases. Combined detection of the three indices has high predictive value for death in elderly patients with severe pneumonia, and may be used as a marker to predict the death in this group of patients.

Key words: Severe pneumonia, 6-hour lactate clearance rate, N-terminal pro-brain natriuretic peptide, Albumin

Ting Wang, Haiming Li, Hongmei Li. Value of 6-hour lactate clearance rate combined with NT-proBNP and albumin detection in prognostic evaluation of elderly patients with severe pneumonia[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(12): 954-959.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2021.12.008

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Figures/Tables 4

项目	存活组（62例）	死亡组（48例）	t/χ²值	P值
年龄（岁， $x ¯$ ±s）	68.38±6.62	69.82±6.8	0.154	0.547
性别［例（%）］
男	35（56%）	28（58%）	0.121	0.702
女	27（43%）	20（42%）	0.101	0.651
吸烟史［例（%）］	31（50%）	26（54%）	0.188	0.664
饮酒史［例（%）］	29（46%）	24（50%）	0.113	0.737
糖尿病［例（%）］	34（54%）	21（43%）	1.331	0.249
高血压［例（%）］	26（42%）	22（45%）	0.167	0.683
脑血管疾病史［例（%）］	25（40%）	21（43%）	0.131	0.718
冠心病［例（%）］	32（51%）	26（54%）	0.071	0.790
BMI（kg/m²， $x ¯$ ±s）	22.57±3.26	23.64±3.12	1.739	0.085
病程（月， $x ¯$ ±s）	6.35±1.34	6.42±1.28	0.277	0.782
收缩压（mmHg， $x ¯$ ±s）	80.67±6.53	78.65±7.34	1.524	0.130
舒张压（mmHg， $x ¯$ ±s）	39.49±4.31	38.48±3.89	1.271	0.206
机械通气（次， $x ¯$ ±s）	48.67±10.26	53.16±11.27	2.180	0.031
ICU住院时间（d， $x ¯$ ±s）	8.92±2.14	15.32±5.61	8.250	＜0.001
白细胞计数（×10⁹/L， $x ¯$ ±s）	3.26±1.25	3.35±1.18	0.384	0.702
血小板计数（×10⁹/L， $x ¯$ ±s）	8.69±2.31	8.34±3.26	0.659	0.512

项目	存活组（62例）	死亡组（48例）	t/χ²值	P值
年龄（岁， $x ¯$ ±s）	68.38±6.62	69.82±6.8	0.154	0.547
性别［例（%）］
男	35（56%）	28（58%）	0.121	0.702
女	27（43%）	20（42%）	0.101	0.651
吸烟史［例（%）］	31（50%）	26（54%）	0.188	0.664
饮酒史［例（%）］	29（46%）	24（50%）	0.113	0.737
糖尿病［例（%）］	34（54%）	21（43%）	1.331	0.249
高血压［例（%）］	26（42%）	22（45%）	0.167	0.683
脑血管疾病史［例（%）］	25（40%）	21（43%）	0.131	0.718
冠心病［例（%）］	32（51%）	26（54%）	0.071	0.790
BMI（kg/m²， $x ¯$ ±s）	22.57±3.26	23.64±3.12	1.739	0.085
病程（月， $x ¯$ ±s）	6.35±1.34	6.42±1.28	0.277	0.782
收缩压（mmHg， $x ¯$ ±s）	80.67±6.53	78.65±7.34	1.524	0.130
舒张压（mmHg， $x ¯$ ±s）	39.49±4.31	38.48±3.89	1.271	0.206
机械通气（次， $x ¯$ ±s）	48.67±10.26	53.16±11.27	2.180	0.031
ICU住院时间（d， $x ¯$ ±s）	8.92±2.14	15.32±5.61	8.250	＜0.001
白细胞计数（×10⁹/L， $x ¯$ ±s）	3.26±1.25	3.35±1.18	0.384	0.702
血小板计数（×10⁹/L， $x ¯$ ±s）	8.69±2.31	8.34±3.26	0.659	0.512

组别	例数	6 h乳酸清除率（%）	NT-proBNP（pg/ml）	ALB（g/L）
存活组	62	27.62±8.65	88.49±16.98	29.68±2.15
死亡组	48	16.35±5.95	186.43±23.26	27.13±2.42
t值		7.719	25.526	5.839
P值		＜0.001	＜0.001	＜0.001

因素	β值	SE	Waldχ²值	P值	OR值	95%CI
机械通气次数	0.229	0.212	1.164	0.281	1.257	0.830~1.905
ICU住院时间	0.305	0.213	2.054	0.152	1.357	0.894~2.060
6 h乳酸清除率	0.710	0.152	21.849	＜0.001	2.035	1.511~2.741
NT-proBNP	1.016	0.120	71.627	＜0.001	2.671	2.182~3.493
ALB	0.757	0.127	35.535	＜0.001	2.132	1.662~2.735

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