| Objective: To investigate the value of procalcitonin(PCT),lactate(Lac)and APACHE Ⅱ score in assessing the condition and predicting the prognosis of patients with sepsis.Methods: Patients with sepsis diagnosed in the Department of Critical Care Medicine(ICU)of the Second Hospital of Guilin Medical College from January 2017 to December 2019 were studied.Patients’ gender,age,site of infection,first blood count,PCT,Lac,C-reactive protein,D-dimer,B-type natriuretic peptide,liver and kidney function were collected and APACHE Ⅱ score were recorded within 24 hours to register survival outcomes at 28 days.Patients were divided into the simple sepsis group and the septic shock group according to the presence or absence of shock.The factors influencing septic shock were analyzed univariately,binary logistic regression analysis was performed for indicators with statistically significant differences,independent risk factors influencing septic shock were calculated,and ROC curves were drawn to assess the predictive value of PCT,Lac and APACHE Ⅱ score on septic shock.Patients were divided into survival and death groups according to their survival status at 28 days.The factors influencing death were analyzed univariately,and binary logistic regression analysis was performed for indicators with statistically significant differences to calculate the independent risk factors affecting the prognosis of sepsis patients.ROC curves were drawn to assess the value of PCT,Lac and APACHE Ⅱ score alone and in combination to predict the prognosis of sepsis.The correlation between PCT and Lac levels and APACHE Ⅱ score in sepsis patients was statistically analyzed.Results: 1.A total of 110 patients were included in the study,of whom 65(59.09%)were male and 45(40.91%)were female.Of the 110 patients,26(23.64%)had simple sepsis,84(73.36%)had septic shock,72(65.45%)survived and 38(34.55%)died.Distribution of infection sites: gastrointestinal perforation in 40 cases(36.36%),biliary system infection in 29 cases(26.36%),pulmonary infection in23 cases(20.91%),urinary tract infection in 15 cases(13.64%)and mediastinal infection in 3 cases(2.73%).2.PCT,Lac,APACHE Ⅱ score,leukocytes,B-type natriuretic peptide,D-dimer and blood creatinine were significantly higher in the septic shock group than in the simple sepsis group [PCT(ng/ml):26.37(7.70,97.76)vs 1.30(0.23,10.98),Lac(mmol/L): 3.80(2.25,6.25)vs 1.50(1.20,2.30),APACHE Ⅱ score(points):(27.74 ± 6.17)vs(19.07 ± 5.50),Leukocytes(*10^9/L): 16.07(7.99,24.44)vs 11.11(5.86,13.67),B-type natriuretic peptide(pg/ml): 2576(1025,14312)vs 616(150,3680),D-dimer(μg/ml): 6.30(3.20,11.01)vs 2.95(1.14,8.55),blood creatinine(umol/L):263(118,342)vs 120(73,224),all P < 0.05],the oxygenation index was significantly lower in the septic shock group than in the sepsis alone group[oxygenation index(mm Hg): 120(73,224)vs 202(118,342),P < 0.05],while there was no statistical in tgender,age,C-reactive protein and albumin between the two groups(P > 0.05).Binary logistic regression analysis revealed that APACHE Ⅱ score(OR=1.233,95% CI:1.065-1.426,P=0.005)was an independent risk factor for septic shock;while PCT,Lac,leukocytes,B-type natriuretic peptide,oxygenation index,D-dimer and blood creatinine had an effect on septic shock,but were not independent risk factors for exacerbation of sepsis(P>0.05).ROC curve analysis of PCT,Lac,and APACHE Ⅱ score showed that the AUC of PCT to predict septic shock was 0.837,with a sensitivity of94.1% and specificity of 53.4% when the cut-off value was 1.67ng/ml;the AUC of Lac to predict septic shock was 0.832,with a sensitivity of 71.8% and specificity of 62.0% when the cut-off value was 2.60mmol/L,and the AUC of APACHE Ⅱ score to predict septic shock was 0.854,with a sensitivity of 82.0%and specificity of 56.5% when the cut-off value was 22.50 points.3.PCT,Lac,APACHE Ⅱ score and blood creatinine were significantly higher in the death group than in the survival group [PCT(ng/ml): 91.64(31.12,194.76)vs 7.14(1.29,22.82),Lac(mmol/L): 5.75(3.78,8.83)vs 2.30(1.38,3.53),and APACHE Ⅱ score(points):(31.00±4.84)vs(22.91±6.43),blood creatinine(μmol/L):263(118,342)vs 120(73,224),both P<0.05],oxygenation index was significantly lower in the death group than in the survival group [oxygenation index(mm Hg): 196(144,262)vs 258(192,311),P < 0.05],while there was no statistical difference in gender,age,leukocytes,C-reactive protein,B-type natriuretic peptide,D-dimer and albumin between the two groups(P >0.05).Binary logistic regression analysis revealed that PCT(OR=1.012,95%CI:1.002-1.021,P=0.013),Lac(OR=1.359,95%:C1.085-1.702,P=0.008),APACHEII score(OR=1.124,95% CI:1.043-1.261,P=0.005)were independent risk factors associated with the prognosis of sepsis death;while blood creatinine and oxygenation index had an effect on the prognosis of sepsis,but were not independent risk factors for death in septic patients(P>0.05).ROC curve analysis of PCT,Lac and APACHE Ⅱ scores alone and in combination showed that the AUC of PCT to predict 28-day death in sepsis was 0.860,with a sensitivity of 73.7% and specificity of 86.5% when the cut-off value was44.43ng/ml;the AUC of Lac to predict 28-day death in sepsis was 0.816,with a sensitivity of 81.8% and specificity of 75.7% when the cut-off value was3.55mmol/L;the AUC of APACHE Ⅱ scores to predict 28-day death in sepsis was 0.852,with a sensitivity of 81.6% and specificity of 78.4% at a cut-off value was 27.50;the AUC of the combination of the three indicators to predict 28-day death in sepsis was 0.909,with a sensitivity of 89.5% and specificity of 86.5%,higher than any single indicator.4.There was a correlation between PCT and Lac expression levels and APACHE Ⅱ score(r=0.565,0.545,both P<0.05).Conclusions: 1.PCT,Lac and APACHE Ⅱ scores are all good clinical indicators for assessing the severity of sepsis,and APACHE Ⅱ score is an independent risk factors for exacerbation of sepsis,while PCT and Lac have some influence on exacerbation of sepsis,but are not independent influencing factors.2.PCT,Lac,and APACHE Ⅱ scores were independent risk factors for sepsis death,and the combined indicators of the three had the highest prognosis for predicting sepsis patients,and had more advantages than a single indicator.3.PCT and Lac are all correlated with APACHE Ⅱ scores. |
PDF Full Text Request