The Prognostic Value Of Multiple Test Indexes And Bedside Lung Ultrasound B-line Combined With Three Scoring Systems In Patients With Sepsis

Part Ⅰ The prognostic value of multiple test indexes and three scoring systems in patients with sepsisObjectiveTo analyze the prognostic value of hypersensitive C-reactive protein(hs-CRP),procalCItonin(PCT),interleukin-6(IL-6),N-terminal pro brain natriuretic peptide(NT-proBNP),D-dimer,lactic acid,Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ),Sequential Organ Failure Assessment(SOFA),and Quick Sequential Organ Failure Assessment(qSOFA)in sepsis patients,so as to scientifically and accurately evaluate the condition and prognosis of sepsis patients and guide clinical diagnosis,treatment and management.Methods234 sepsis patients were selected from November 2019 to August 2022 in the ICU of Building 2,East Hospital,Shandong Provincial Hospital.The worst clinical data of patients were collected within 24 hours,and APACHE Ⅱ,SOFA,qSOFA scores were calculated,randomly selected some patients to detect 12 cytokines within 72 hours,and divided them into survival group and death group according to 28-day outcomes.The differences between hs-CRP,PCT,IL-6,NT-proBNP,D-dimer,lactic acid and APACHE Ⅱ,SOFA,qSOFA scores were compared in the serum of patients in the two groups,and the correlation between the indicators were analyzed.The evaluation value of the above test indexes and three scoring systems on the prognosis of sepsis patients was compared.Results1.There were significant differences in age,PCT,IL-6,NT proBNP,lactic acid,APACHE Ⅱ,SOFA,qSOFA scores between the survival group and the death group(P<0.05),but there were no significant differences in gender,hs CRP,D-dimer,creatinine between the two groups(P>0.05);2.There was no significant difference in 12 cytokines between survival group and death group in 33 patients with sepsis patients(P>0.05);3.APACHE Ⅱ was positively correlated with PCT(rs=0.370),NT-proBNP(rs=0.327),lactic acid(rs=0.324),Creatinine(rs=0.428),SOFA(rs=0.680),and qSOFA(rs=0.517);SOFA was positively correlated with PCT(rs=0.569),IL-6(rs=0.367),NT-proBNP(rs=0.479),lactic acid(rs=0.424),creatinine(rs=0.493),and qSOFA(rs=0.528);The 28-day mortality was positively correlated with creatinine(rs=0.326),APACHE Ⅱ(rs=0.371),SOFA(rs=0.349)and qSOFA(rs=0.390).4.PCT,creatinine,APACHE Ⅱ and qSOFA score had significant value in predicting the prognosis of sepsis patients(P<0.05).The higher lactic acid(OR=1.378,95%CI 1.07-1.78,P=0.014),APACHE Ⅱ score(OR=1.086,95%CI 1.02-1.15,P=0.006)and qSOFA score(OR=2.268,95%CI 1.35-3.81,P=0.002),the higher the risk of death;However,there was no significant differences between IL-6,NT-proBNP,and SOFA scores on the prognosis of sepsis patients(P>0.05);5.AUC of hs CRP,PCT,IL-6,NT proBNP were all<0.7,and lactic acid was the highest(0.697);APACHE Ⅱ,SOFA,and qSOFA score have predictive value for the death of sepsis patients.QSOFA had the highest specificity(79.8%)in evaluating sepsis,which had predictive value for the death of sepsis patients.APACHE Ⅱ and qSOFA scores combined with lactic acid respectively showed that qSOFA combined with lactic acid had the highest sensitivity(80.5%).Conclusion1.The PCT,IL-6,NT-proBNP,lactic acid,APACHE Ⅱ,SOFA,qSOFA scores were higher in the death group,which had certain application value in diagnosing the severity stratification of ICU sepsis patients;2.Lactic acid,APACHE Ⅱ,SOFA,qSOFA scores were positively correlated with 28-day mortality,which could reflect the mortality risk of sepsis patients;3.PCT,lactic acid,APACHE Ⅱ,qSOFA scores are independent risk factors for the death end point events of ICU sepsis patients,which can be used as important indicators for the prognosis evaluation of ICU sepsis patients,while hs-CRP,IL-6,NT-proBNP,SOFA score had no significant prognostic value for the prognosis of ICU sepsis patients;4.The qSOFA score has evaluation value for the prognosis of sepsis patients.The combination of APACHE Ⅱ and SOFA score can improve the sensitivity of diagnosis,and the combination of lactic acid can significantly improve the sensitivity.Moreover,the qSOFA score has the advantages of non-invasive and rapid acquisition,which has important application value for evaluating the prognosis of sepsis patients.Part Ⅱ Prognostic value of bedside lung ultrasound B-line score combined with qSOFA score in patients with sepsisObjectiveTo analyze the prognostic value of lung ultrasound B-line combined with APACHE Ⅱ,SOFA,qSOFA scores in sepsis patients,so as to quickly and accurately evaluate the condition and prognosis of sepsis patients.Methods101 sepsis patients were selected from May 2021 to August 2022 in ICU of Building 2,East Hospital,Shandong Provincial Hospital.Collect the worst clinical data of patients within 24 hours,calculate APACHE Ⅱ,SOFA,qSOFA scores,and record the B-line score of bedside lung ultrasound within 72 hours.According to the 28-day outcomes,the patients were divided into survival group and death group.The B-line score of lung ultrasound and APACHE Ⅱ,SOFA,qSOFA scores were compared in the two groups,and the correlations between the B-line of lung ultrasound and each index were analyzed.Evaluated the statistical significance of lung ultrasound B-line score and qSOFA score on the death of patients,and analyzed the prognostic value of lung ultrasound B-line score combined with three scoring systems on sepsis patients.Results1.Lung ultrasound B-line score,APACHE Ⅱ,SOFA,and qSOFA scores were significantly different in the two groups of sepsis patients(P<0.05);2.B-line score was positively correlated with NT proBNP(rs=0.206,P=0.039),SOFA(rs=0.208,P=0.037),and 28-day mortality risk(rs=0.230,P=0.021);3.The influence of lung ultrasound B-line score and qSOFA score on the death of sepsis patients was statistically significant.The higher the lung ultrasound B-line score,the higher the risk of 28-day mortality(OR=1.061,95%CI 1.007-1.117,P<0.05);The higher the qSOFA score,the higher the risk of 28-day mortality(OR=2.915,95%CI 1.338-6.349,P<0.05);4.The specificity of B-line ultrasound in evaluating the prognosis of sepsis patients was the highest(93.3%),and the specificity of B-line combined with SOFA was also 93.3%,but the sensitivity was poor(42.3%).The sensitivity of B-line combined with qSOFA score was improved(61.5%),and the specificity was still high(84%),which was higher than the specificity of three combined scores(81%),and could be used as an important indicator for evaluating the prognosis of sepsis patients.Conclusion1.The integral level of B-line ultrasound in the dead group was higher,which had certain application value in diagnosing the severity stratification of ICU sepsis patients;2.There was a positive correlation between lung ultrasound B-line score and the 28-day mortality rate,and there was a certain relationship with the prognosis of patients;3.Lung ultrasound B-line score and qSOFA score are independent risk factors for death end point event of ICU sepsis patients,and can be used as important indicators for prognosis evaluation of sepsis patients;4.Lung ultrasound B-line can improve the specificity of evaluating the prognosis of sepsis patients,and the sensitivity of evaluation can be improved after combining with qSOFA score.Moreover,both lung ultrasound B-line and qSOFA score have the advantages of non-invasive and rapid acquisition,which can be used as an important strategy to evaluate the prognosis of sepsis patients in ICU.