The Value Of Gelsolin Level For Evaluating The Severity And Prognosis Of Patients With Critical Care

OBJECTIVETo compare the gelsolin level with acute physiology and chronic health evaluationⅡ(APACHEⅡ) score and to associate the gelsolin level with APACHEⅡscore, to investigate the value of gelsoin for evaluating the severity and prognosis of patients with critical care.METHOD48 patients with critical care were enrolled in this study, who was admitted to the Emergency Rescuing Room or Intensive Care Unit of Beijing Hospital during February to December in 2008.31 patients were given gelsolin level test at least two times during hospitalization, while the gelsolin level of 17 patients were only measured at the first visit. In addition, the APACHEⅡscore of each patient was adopted within 24 hours after admission. We evaluate the severity and prognosis of patients by the both of methods. The gelsolin levels of 304 healthy people were obtained as controls.RESULTSWe find that the initial gelsolin level of patients with critical care is far less than control (24.04±11.28mg/l vs 192.03±39.48mg/l, P<0.001). The initial gelsolin level in surviving group(23 cases) is 27.62±9.58mg/l, while that of the death group(25 cases) is 20.74±11.89mg/l, which have statistical significance(P=0.033). The initial value of gelsolin level is in slight negative correlation with the severity of patients (death termination) (r=-0.306, P=0.035), and its final value is also in negative correlation with the severity of patients(death termination) (r=-0.469, P=0.008), whose death predicting accuracy rate is 74.19%, that is, when its final value is 22mg/l or less, the patients' mortality increases. Besides, the changing tendency of gelsolin level at the terminal point has the same correlation with the severity of patients (r=0.485,P=0.006), whose death predicting accuracy is 74.19%.The general changing tendency of gelsolin level also correlates with the severity of patients (r=0.418,P=0.019), with the rate of predicting accuracy reaching 70.97%. The APACHEⅡscore obtained from the survivals (23 cases) and the deads (25 cases) are respectively 22.26±6.49 and 29.24±8.56, which have statistical significance (P=0.003).When APACHEⅡscore is 30 or more, the death predicting accuracy rate amounts to 67.74%.When APACHEⅡscore is applied combining with the final value, the changing tendency at the terminal point or the general changing tendency of gelsolin level to make prognosis assessment, the predicting accuracy rate can reach 93.55%.CONCLUSIONThe severity of patients with critical care can be reflected by gelsolin level. And continuous measuring of gelsolin level seems surpass to APACHEⅡscore in evaluating the severity of patients. Moreover, the association of gelsolin level with APACHEⅡscore shows a more accurate prognosis assessment.