| Objectives:To investigate the roles of soluble triggering receptor expressed anmyelaid cells-1 in patient with sepsis.Methods: 1 This was a prospective、observational study of adult patients admitted to the intensive care unit(ICU)of the Shijiazhuang City Hospital of Traditional Chinese Medicine between January to December 2016,who were screened for the ACCP/SCCM criteria for sepsis on admission(n=40).According to the 2016 International Sepsis Guidelines 3.0 standard,the cases were divided into two subgroups:general sepsis group(n=23)and septic shock group(n=17)。Meanwhile,take the same period of systemic inflammatory response syndrome(SIRS)patients as control group(n=15).The sepsis cases were divided into survival group(n=)and non-survival group(n=15)according to 28 day mortality rate.Collected the patients general data,recorded vital signs and other basic informations.Detected blood count,coagulation、biochemistry、blood gas analysis and other indicators by the conventional method,calculated the acute physiology and chronic health evaluation II score(APACHEⅡscore),systemic infection related organ failure assessment(SOFA score)and Quick SOFA score(qSOFA).2 Collected the blood samples immediately after the patients admission to the ICU,the surum samples were frozen at-20℃.Crefrigerator after centrifugation to prepare for reunifical:sTREM-1 and Angiopoietin-2,were measured by enzyme linked immunosorbent assay(ELISA).3 Results analysis 3.1 There was no significant difference between serum sTREM-1 level,serum Ang-2 level and serum PCT level,APACHE Ⅱscore and SOFA score in sepsis group and SIRS group.There was no difference between death group and survival group Statistical significance.3.2 The correlation between serum sTREM-1 level,serum Ang-2 level and serum PCT level,APACHE score aⅡ nd SOFA score were analyzed.3.3 The value of serum sTREM-1,serum Ang-2,serum PCT,APACHE and ⅡSOFA were evaluated in the diagnosis and prognosis of sepsis by drawing ROC curve.4 statistical methods: SPSS13.0 statistical software for statistical treatment,P<0.05 for the difference was statistically significant.Count data using χ2 test.The normal distribution data were expressed as mean ± standard deviation(± s).The t test was used between the two groups.The variance analysis was used in the multiple groups.The non-normal distribution measures the median(quartile)The Mann-Whitney U test was used between the two groups,and the Kruskal-Wallis H test was used for comparison between groups.Pearson or Spearman correlation analysis based on whether or not a normal distribution is used.The subjects’ characteristic curve(ROC curve)was drawn and the indexes were used to evaluate the diagnostic value and prognosis of sepsis.Results:1 A total of 40 patients with sepsis were enrolled in the study.There were males(n=26)and females(n=14)with an average age of 64.60±15.21 years.There were SRIS(n=15)controls,including males(n=11)and females(n=4)with a median age of 64(51,76.4).There was no significant difference in sex and age among the three groups(P>0.05).2 Compared with SIRS group,the levels of sTREM-1 in sepsis group and septic shock group were significantly different between the sepsis group and the sepsis group(P<0.05)(P>0.05).There was no significant difference in serum sTREM-1 level between the sepsis group and the sepsis group(P>0.05).The difference of serum PCT level,APACHE Ⅱscore and SOFA score between the three groups was statistically significant(P<0.05).There was no significant difference in serum Ang-2 level between the three groups(P>0.05).3 Correlation analysis of sepsis diagnostic markers: Spearman method was used to calculate the correlation coefficient R and P value.There was a positive correlation between the APACHE II score and the SOFA score(R=0.788,P=0.000).The level of serum PCT was positively correlated with the APACHE II score and SOFA score(R=0.702,0.565,P<0.05).Serum sTREM-1 level was correlated with APACHE II score,SOFA score and serum PCT level(R=0.479,0.332,0.597,P<0.05);serum Ang-2 level was correlated with APACHE II score R=0.788,P<0.05).Ang-2 was not correlated with SOFA score and serum PCT level(R=-0.19,P>0.05).4 ROC curve to diagnose the significance of sepsis: ROC curves of sepsis were determined by plotting the receiver’s characteristic curve(ROC curve)to obtain serum sTREM-1,serum Ang-2,serum PCT,APACHE II score,SOFA score The area under the APACHE II curve was 92.5% and the specificity was 86.7%.The sensitivity of the serum sTREM-1 to diagnose sepsis was 81.5% and the specificity was 66.7% %,Diagnostic ability is medium.The sensitivity of serum Ang-2 was 37.5% and the specificity was 73.3%.The diagnostic accuracy was low.Serum PCT combined with APACHE Ⅱor serum PCT combined SOFA score can improve the diagnostic sensitivity of sepsis to 97%,specificity were 75.6%,73.3%,showing the obvious advantages of sepsis diagnosis.5 Evaluation of sepsis prognosis: sepsis death group ICU initial detection of serum sTREM-1,PCT levels and APACHE II score,SOFA scores were higher than the survival group,the difference was statistically significant(P<0.05).There was no significant difference in serum Ang-2 level between the first group and the survival group(P>0.05).6 Prediction of sepsis death: serum sTREM-1,serum Ang-2,serum PCT,APACHE II score,SOFA score diagnosis of sepsis under the ROC curve area were 0.839,0.468,0.906,0.810,0.803.Serum sTREM-1 predicts sepsis death is the best cut-off point is 587.375pg/ml,sensitivity is 87.1%,specificity is 70%;PCT predicts sepsis death is the best cut-off point is 12.45 ng / ml,predicting pus The sensitivity of death was 96.8% and the specificity was 80%.APACHE II score predicts sepsis death is the best cut-off point is 25.5,predicting sepsis death sensitivity is 93.5%,specificity is 80%.SOFA score predicts sepsis death is the best cut-off point is 11.5,predicting sepsis death sensitivity is 87.1%,specificity is 70%.The PCT PCT combined with APACHE II score,serum PCT combined SOFA score and serum PCT combined with serum sTREM-1 could increase the sensitivity of death to 94% and 87.5%,82.5% and 82.5%,respectively,with the combination of two factors.Conclusion:1 Serum sTREM-1,PCT level,APACHE II score and SOFA score in patients with sepsis were higher than those in non-sepsis group.Serum sTREM-1 levels were used for early diagnosis of sepsis,PCT level,APACHE II score and SOFA score Compared with a higher sensitivity and specificity.2 The serum sTREM-1 levels in sepsis patients were positively correlated with APACHE II score,SOFA score and PCT,and could be used to assess the severity of sepsis.3 serum sTREM-1 level,PCT,APACHEII score,SOFA score in the sepsis death group were higher than the survival group,serum sTREM-1 level with moderate prediction of sepsis death ability.Two factors combine to improve the ability of septic death prediction. |
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