Predictive value of dynamic monitoring of serum related indexes for pulmonary infection after severe craniocerebral injury

  Objective  To analyze the value of dynamic monitoring of serum procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and ratio of C-reaction protein to albumin (CRP/ALB) changes in early predicting pulmonary infection after severe craniocerebral injury.

  Methods  A total of 196 patients with severe craniocerebral injury treated by surgery were selected, the serum PCT, CRP, ALB, sTREM-1 and CRP/ALB levels at 1 day, 3 and 5 days after operation were monitored and recorded, and the postoperative pulmonary infection conditions were recorded as well. Risk factors for pulmonary infection after severe craniocerebral injury were analyzed. The receiver operating characteristic (ROC) curve was drawn to analyze the early predictive value of related indicators for pulmonary infection.

  Results  There were 76 cases (38.78%) with pulmonary infection after operation for severe craniocerebral injury, and the infection occurred at 6 to 13 days after operation with a median of 7 days. The levels of serum PCT, sTREM-1 and CRP/ALB in the non-pulmonary infection group were significantly lower than those in the pulmonary infection group at 3 and 5 days after operation (P < 0.05). The serum ALB in the pulmonary infection group was significantly lower than that in the non-pulmonary infection group at 5 days after operation (P < 0.05). The time of mechanical ventilation, postoperative Glasgow Coma Scale (GCS) score, postoperative Acute Physiology and Chronic Health Score Ⅱ (APACHE Ⅱ) and serum PCT, sTREM-1 and CRP/ALB at 5 days after operation were the independent risk factors for postoperative pulmonary infection (P < 0.05). ROC curve showed that area under curve (AUC), Youden index and specificity of single detection of serum CRP/ALB were the highest in predicting pulmonary infection at 5 days after operation, and the sTREM-1 was the most sensitive. The Clinical Pulmonary Infection Score (CPIS) and modified Systemic Inflammatory Response Syndrome Score (ASS) were positively correlated with the levels of PCT, sTREM-1 and CRP/ALB at 5 days after operation (P < 0.05).

  Conclusion  The serum PCT, sTREM-1 and CRP/ALB levels at 5 days after operation can be used as the effective evidences for early prediction of pulmonary infection after severe craniocerebral injury, and the combined detection is more valuable and conducive to the early assessment of the degree of pulmonary infection and the progress of the disease.