Vascular Endothelial Growth Factor Levels In Severe Sepsis And Its Pathogens Study

Vascular endothelial growth factor is a growth factor that acts at vascular endothelial cells,with the function of increasing microvascular permeability.Its function in sepsis has been put so much attention abroad,yet there is not so much at home.Objective:Vascular endothelial growth factor is a growth factor that acts at vascular endothelial cells,with the function of increasing microvascular permeability.Its function in sepsis has been put so much attention abroad,yet there is not so much at home.The aim of the study was to examine VEGF levels in severe sepsis serum, show its significance to the prognosis.To know about the situation of the pathogen and its drug resistance outside the body,meanwhile provide a foundation for therapy.Methods:1.Enroll the severe sepsis patients basic informations who were hospitalized in emergency center and ICU of some hospital from July 2006 to October 2007.Record clinical and laboratory dates on the 1^st,3^rd,7^thday,and calculate APACHEII score.Divide the patients into survival group and death group according to 28 day lasting.2.Examine the VEGF levels on the 1^st,3^rd,7^thday by ELISA.3.Collected the pathogens of the severe sepsis patients and MIC antibacterial activity.4.statistical methods:Qualitative dates analysed by x²-test.Quantitative dates analysed by t-test or F-test.Do the bivariate analysis between the VEGF levels and other dates as age,HR,MAP,PLT,WBC,ALB,C-RP,LAC.Apply binary logistic regression to do statistical dealings.Select the risk factors and draw the ROC curre.Results:1.There are 29 severe sepsis patients including 18 male ones and 11 female ones.16 cases survived and 13 ones died.The case fatality rate is 44.8%.The pathogenies are severe pneumonia(24.14%),catheter-relatedinfection(17.24%), acutepyelonephritis(10.34%),others(48.3%)2.Apply ELISA the VEGF levels in the control group is 78.77±8.15pg/ml,in the survival group on the 1^st,3^rd,7^thday are 210.47±59.40pg/ml,161.79±32.58pg/ml,85.33±12.13pg/ml,the peak value appeared on the 1^stday.the VEGF levels decreased with the development of the disease.There has not statistical difference between control group and survival group on the 7^thday(p＞0.05).In the death group,VEGF levels on the 1^st,3^rd,7^thday are 324.12±44.35pg/ml,185.40±30.92pg/ml,273.32±55.23pg/ml,all of which are higher than the control group,the peak value also appeared on the 1^stday,but it decreased unconspicuously on the 7^thday,it is obviously higher than the control group (p＜0.01).VEGF levels in death group on the 1^st,7^thday are higher than survival group,which has statistical difference(t=-5.717,p＜0.01 and t=-10.604,p＜0.01).On the 3^rdday the difference is unconspicuously(t=-1.888,p＞0.05).3.Through bivariate analysis,VEGF levels has positive relation with APACHEII score (r=0.510,p＜0.01),negative relation with PLT(r=-0.221,p＜0.05),and no relation with other parameters(p＞0.05).Bringing age,APACHEIIscore,HR,MAP,WBC,PLT,C-RP, ALB and VEGF levels into unconditional Logistic regression,the results show the VEGF levels,APACHEII score and age are risk factors that can influence the prognosis(p＜0.05).4.In this study 93 pathogens are separated.Of 93 clinical isolated,the Gram-negative organism accounted for 47,the Gram-positive organism 27,fungi 19.The main pathogens are Pseudomons aeruginosa(12),staphyloccus aureus(12),E.coli(10),cavdida pneumonia(9),Pseudomonas aeruginosa drug resistance rate to cefepime,ciprofloxacin,imipenem are all higher than 60%.All the staphyloccus aureus are susceptive to vancomycin,the separation rate of MRSA is 83.3%.The 19 fungi drug resistance rate to antifungi medicine are all lower than 20%.Conclusions:VEGF levels in severe sepsis patients are higher than the control group on the 1^st day.It decreases in the course of disease in the survival group,but it decreases unconspicuously in death group.VEGF levels is positively related with APACHEII score and negatively related with PLT.VEGF levels,APACHEII score and age are risk factors for death.In this study pseudomonas aeruginosa,staphyloccus aureus, E.coli are the main pathogens,which are mutil-drug resistance.