| Background and Objective: Sepsis is a systemic inflammatory response(SIRS)caused by infection,which is also a severe trauma,burns,infection,shock,one of the complications of acute critical illness,with the progression of the disease leading to severe sepsis,septic shock and multiple organ failure(MODS).It has become one of the main causes of death in the intensive care unit(ICU).According to statistics,there are about 18 million patients with sepsis in global at present,and the number of people who have died from sepsis each year more than 200 thousand.As a result,it is essential to improve the diagnosis and treatment of sepsis.Sepsis has obvious heterogeneity and pathogenic bacteria,so its early diagnosis and treatment become a problem of ICU.The central link in sepsis is the inflammatory response that runs through the whole process of the pathological and physiological processes.The release of inflammatory mediators and inflammatory cell infiltration lead to the release of inflammatory mediators waterfall systemic inflammatory response,and causing harm to the body,mediators of inflammation mediated inflammation injury of cell structure and function,even local tissue and organ dysfunction.Further development of that induced tissue ischemia,hypoxia,perfusion,blood coagulation dysfunction,even death caused by septic shock.Although a variety of inflammatory markers have been found in the diagnosis of sepsis,however,each inflammatory marker has a suitable range of usefulness.There are some limitations in the diagnosis and prognosis of sepsis.Now more clinical applications of combined detection of multiple biomarkers in sepsis were used,which may improve the diagnosis of sepsis,prevent sepsis in patients with progression,judge the prognosis,guide the clinical use of antimicrobial agents,evaluate its efficacy and predict the development of organ dysfunction.It is more dominant than a single index for sepsis.This study discusses the application value of common biomarkers such asneutrophil gelatinase associated lipocalin(NGAL),procalcitonin(PCT),B-type natriuretic peptide(BNP),lactate and Acute physiology and chronic health Ⅱevaluation(APACHE Ⅱ)score in the intensive care unit in patients with sepsis.Methods: Dates of 105 patients admitted to our hospital comprehensive ICU from January 2015 to 2015 December were collected,including 73 males,32 females with mean age(57.9±18.5)years.These patients were divided into 62 cases of sepsis,23 cases of severe sepsis and 20 cases of septic shock.At the same time,194 non-sepsis patients with ICU were selected,among them122 were male and 72 were female,the average age was(53.8±18.8)years.The general information of patients were collected after admission.These informations consist of blood samples of patients sent blood toutine,liver and kidney function,electrolyte,blood gas analysis,neutrophil gelatinase associated lipocalin(NGAL),procalcitonin(PCT),BNP,etc.According to the discharge status them were divided into survival group and death group,to analyze the relationship of the disease severity and prognosis,using SPSS17.0 statistical analysis.Normal distribution measurement data use mean(x)± standard deviation(s),and different groups comparison employe two independent samples t test;Nonnormal distribution of the measured data use the median(P25~P75)and comparisons between different groups use Mann — Whitney U test.Logistic regression analysis was used to calculate the risk index of the prognosis of patients with sepsis.The application value of NGAL,PCT,BNP,Lac and APACHEⅡscore in patients with sepsis were evaluated by the receiver operating characteristic(ROC)curve and area under roc curve(AUC).P<0.05 for difference was statistically significant.Results: 1.Comparisons between the different severity of sepsis groups and controlled group were following.Ages,body temperatures,breathings,heart rates in general groups were higher than those in the controlled group.The difference was statistically significant(P < 0.05).White blood cell counts in the severe sepsis group were higher than those in the control group and general sepsis group,but the body temperatures were lower.The difference was statistically significant(P < 0.05).Septic groups body temperatures,respirations,heart rates were higher than the controlled group.the difference was significant(P<0.05).The total of sepsis group body temperatures,respirations,heart rates,white blood cell counts were higher than control group,the difference was significant(P< 0.05).2.Comparisons of NGAL,PCT,Lac,BNP and APACHEⅡ score in different severity sepsis and control group: The levels of NGAL,PCT,Lac and APACHEⅡ scores in the sepsis group were higher than those in the control group,the difference was significant(P <0.05),the levels of NGAL,PCT,APACHEⅡ score and BNP in severe sepsis group were higher than those in control group and sepsis group,the difference was significant(P < 0.05),Lac was higher than that in control group,the difference was significant(P < 0.05),the levels of NGAL,PCT and APACHEⅡ score in septic shock group were higher than those in control group and sepsis group,BNP was lower than sepsis group and lactate was higher than that in control group,the difference was significant(P < 0.05),the levels of NGAL,PCT,Lac and APACHEⅡ score in the total of sepsis group were higher than those in control group,the difference was significant(P < 0.05).3.Comparison of biomarkers and APACHEⅡ score between the death group and the survival group: The levels of NGAL,PCT,Lac,APACHEⅡ score and BNP in the death group were higher than those in survival group.The difference was significant(P < 0.05).4.Analysis of ROC curve of biomarkers and APACHEⅡ score in patients with sepsis: The area under the ROC curve for NGAL,PCT,Lac,APACHEⅡ score,and BNP in sepsis patients showed that the above indexes in the diagnosis of sepsis,the area under the curve were respectively 0.785,0.869,0.759,0.723,0.754;The Younger Index were respectively 0.500,0.696,0.445,0.333,0.443.5.Comparison of biomarkers and APACHEⅡ score the ROC curves between the death group and the survival group: The area under the ROC curve of NGAL,PCT,Lac,APACHEⅡ score and BNP in the death group and the survival group were analyzed,The area under the curves of the above indexes in assessing the prognosis of sepsis were respectively 0.863,0.717,0.799,0.753,0.680,index were respectively 0.648,0.385,0.604,0.489,0.359.6.The results of Logistic regression analysis: The independent risk factors associated of mortality in patients with sepsis were Lac(OR=1.119,P=0.035).Conclusions: 1.The PCT is a highly specific indicator for the diagnosis of sepsis,combining with NGAL,Lac and BNP can improve the sensitivity of the diagnosis of sepsis than PCT.2.NGAL combined with lactate to predict the high accuracy of death in patients with sepsis;Lac is an independent risk factor for mortality of sepsis,which can directly reflect the severity of the disease and the prognosis of the disease. |
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