Clinical Study On Relationship Between Protein C Level And Prognosis In Patients With Severe Sepsis

ObjectProtein C(PC)is a vitamin K-dependent glycoprotein which has anticoagulant effect.It plays an important role in sepsis.This study is to select patients with severe severe sepsis,analyze the relationship between PC and prognosis in order to cure as early as possiable and reduce mortality.Methods1.Select 30 patients with severe sepsis as the patient group who were admitted to ICU between October,2006 and October,2007.Collect blood samples to measure PC and the specimens in sites suspected of being infected to microbial culture,based on recording clinical data and 28-day mortality,we divided the patients into survival group and nonsurvival group.24 healthy controls are included in the study.2.PC level measured by double-antibody sandwich ELISA.3.Identified strains by conventional method.4.Statistical analysis:Adoptingχ²-test method in comparing the.qualitative data and two independent samples t-test in two groups.More than two groups,using one-way ANOVA,using Spearman correlation to analysis the correlation between PC and other clinical indicators.Applying Logistic regression analysis to assess the risk factors of death in patients with severe sepsis.Evaluate the diagnostic accuracy of the PC by ROC curves.SPSS13.0 software used for statistical analysis,and a two-tailed P-value＜0.05 was considered significant.Results1.In patient group,17 survivors and 13 nonsurvivors.Compared with the control group,PL decreased(P＜0.05)and D-D increased(P＜0.05)on the 1^st,3^th,7^th day,and PT,APTT extended significantly on the 7^thday(P＜0.05).MPV extended on the 3^thday only(P＜0.05).Compared with survival group,PL decreased on the 1^st,3^th, 7^thday(P＜0.05),D-D increased(P＜0.05)in nonsurvival group.MODS score, APACHEâ…¡score in nonsurvival are significantly higher than those survival(P ＜0.01).2.PC detection of double-antibody sandwich ELISA absorbance detection standard,drawing standard curve.In patient Group,PC level on the 1^st,3^th,7^thday are(1778.0±638.2)ng/ml,(2035.9±749.6)ng/ml,(2608.6±900.1)ng/ml,were significantly lower than that in the control group[(3819.8±214.0)ng/ml](q = 15.086,13.181,8.945,P＜0.000].The PC level are significant lower in death than that in alive(t =-5.558,-7.481,-6.796,P＜0.001).3.There was positively correlated between PCl and PL(ρ=0.446,P =0.013). PC1 was negatively correlated with D-D(ρ= -0.427,P =0.019),the numbers of organ failure(ρ=-0.578,P= 0.001),APACHEâ…¡(ρ=-0.649,P＜0.001),MODS score(ρ=-0.635,P＜0.001).There were no correlations between PC and PT,APTT, TT and FBG(P＞0.05).4.The results from Logistic regression analysis show that the factors significantly related with death in patients with severe sepsis include:PC1, APACHEⅡ≥20,MODS score≥5,the numbers of organ failure≥3.5.Area under the ROC curve,in PC1 is bigger than APACHEâ…¡and MODS score.6.75 Bacillus were collected,including Gram negative 34,Gram positive 25, fungal 16,Pseudomonas aeruginosa,Staphylococcus aureus,Candida albicans are the first three pathogens.Conclusion1.In this study,28-day mortality of severe sepsis is 43.3%.2.The lower the PC level is,the higher the APACHEâ…¡and MODS score are,the worse the prognosis is.The PC level on 1^stday is better than APACHEâ…¡score and MODS score in the value of predicting the prognosis in patients with severe sepsis, And it can be used for predicting prognosis.3.In coagulation indicators,the early increase in D-D and decrease in PL,MPV suggest worse outcome.4.In this study,pathogenic bacteria are mainly multi-drug resistant.