The Role Of Soluble Thrombomodulin In The Risk Stratification And Prognosis Evaluation Of Septic Patients In Intensive Care Unit

Objective:The purpose of this study is to identify the role of sTM in the evaluation of the severity and prognosis of septic patients in ICU,and to compare the predictive value of sTM with biomarkers such as NGAL,PCT,SOFA and APACHE II respectively,and to explore the methods of predicting the condition and prognosis of patients with sepsis.Methods:The data of eligible septic patients in the emergency ICU of the First Affiliated Hospital of Nanchang University were collected from January to December in2019.The levels of sTM,PCT and NGAL at the time of enrollment were measured,the SOFA score and APACHE II score were calculated,and the survival conditions of all patients were followed up for 28 days.The predictive value of biomarkers and scores for septic shock and 28-day mortality were evaluated by multivariate logistic regression and ROC curve.Results:75 patients were enrolled.They were divided into the group of septic shock(29)and the group of non septic shock(46)according to whether developing into septic shock after admission.In addition,patients were divided into the survival group(58)and non-survival group(17)according to the survival condition of 28-day.The level of sTM in the group of septic shock was significantly higher than that in the group of non septic shock(P < 0.001),while that in the group of non-survival was significantly higher than that in survival group(P < 0.001).Multivariate logistic regression analysis showed that sTM was a predictor of septic shock and 28-day mortality(P <0.05).The ROC curve analysis showed that the AUC of sTM in predicting septic shock was 0.943(P < 0.001),Which is higher than NGAL(0.94),PCT(0.884),SOFA score(0.902),APACHE II score(0.81).When single biomarker or score combinedwith sTM in predicting septic shock,the AUC value of SOFA+ sTM was 0.978(P <0.001),which was higher than NGAL + sTM(0.976),PCT + sTM(0.972)and APACHE II score + sTM(0.954).The AUC value of sTM was 0.887(P < 0.001),which is higher than NGAL(0.801),SOFA score(0.777),PCT(0.771)and APACHE II score(0.77)in predicting 28-day mortality.When single biomarker or score combined with sTM,the AUC value of NGAL + sTM was 0.896(P < 0.001),higher than SOFA score + sTM(0.894),APACHE II score + sTM(0.891)and PCT +sTM(0.889).The cutoff value of sTM for predicting septic shock was 78.57ng/ml,with a sensitivity of 0.802 and a specificity of 0.889.The cutoff value of sTM for28-day mortality was 79.85ng/ml,with a sensitivity of 0.824 and a specificity of0.897.The value of specificity and sensitivity of the single index or score combined with sTM were better than single biomarker or score in predicting septic shock and28-day mortality.Conclusions:(1)The sTM has a good predictive value for the risk stratification and prognosis evaluation of sepsis in ICU.(2)The NGAL,PCT,SOFA score,and APACHE II score combined with sTM to predict sepsis shock and 28-day mortality are more meaningful than individual indicators or score.(3)The SOFA score is more significant than the APACHE II score to predict sepsis shock and 28-day mortality.(4)The NGAL is more significant than the PCT in predicting sepsis shock and28-day mortality.(5)The value SOFA score combined with sTM is higher than that of APACHE II score combined with sTM in predicting septic shock and 28-day mortality.