| Objective:To investigate the significance of Soluble growth stimulating gene 2 protein(sST2)in sepsis patients;To evaluate the relationship between serum sST2 levels and the severity of sepsis patients;To evaluate the prognostic role of the severity scoring systems in patients with sepsis in the emergency department and to evaluate the combined predictive value of sST2 and the severity scoring systems;To explore the characteristics of sST2 and traditional biomarkers in prognosis evaluation and the value of combination of multiple biomarkers;To explore the risk factors of adverse events in patients with sepsis.Providing new clinical evidence for clinical therapy and prediction of prognosis in sepsis patients.Methods:Clinical data,including general clinical data,severity scoring systems,relevant laboratories and examinations,and treatment were collected from sepsis patients admitted to the emergency intensive care unit of the First Affiliated Hospital of China Medical University from October 2020 to July 20 22,and 343 eligible patients were screened according to the Inclusion and exclusion criteria.First of all,patients were divided into survival group(n=189)and non-survival group(n=154)according to whether they died of illness within 28 days after admission,and the difference of baseline data between the two groups was compared;Spearman correlation analysis was used to evaluate the correlationship between sST2 and other parameters;ROC analysis was used to evaluate the predictive value of sST2,severity scoring systems and other serum biomarkers for 28 day mortality;Univariate logistic regression analysis was used to determine whether sST2 could be used as an prognostic factor.Multivariate logistic regression analysis was used to identify the independent risk factors of 28-day mortality in patients with sepsis.Results:1.This study included 343 patients,including 189 patients in the survival group and 154 patients in the non-survival group.including 38 cases of urinary system infection,24 cases of skin and subcutaneous tissue infection,202 cases of lung infection,35 cases of liver,biliary system and pancreas infection,and 44 cases of other intraperitoneal infections.Compared with the survival group,the non-survival group had higher proportion of septic shock(P<0.001)and mechanical ventilation(P<0.001),higher levels of plasma prothrombin time(P<0.001),arterial blood Lactate(P<0.001),procalcitonin(P=0.002),troponin Ⅰ(P=0.013),NT proBNP(P<0.001),and sST2(P<0.001),The difference was statistically significant;The platelet levels(P=0.037),albumin levels(P<0.001),and left ventricular ejection fraction(P=0.038)in the death group were significantly lower than those in the survival group.At the same time,the death group also had relatively higher scores.(All P<0.001).2.All patients were divided into low sST2 level group(22.5-75.60 ng/mL),mledium sST2 level group(75.7124.20 ng/mL),and high sST2 level group(>124.3 ng/mL)according to the level of sST2.The mortality rates of the three groups were compared,and the differences of clinical data were analyzed.The results showed that with the increase of the level of sST2,the mortality of patients increased sigmiificantly(P<0.001),and there were significant differences between the three groups in the intergroup comparisons of septic shock ratio,platelets,plasma prothrombin time,albumin,blood lactate,procalcitonin,troponin Ⅰ,NT-proBNP,left ventricular ejection fraction,SOFA score,APACHE Ⅱ score,and SAPS Ⅱ score levels(all P<0.05).3.Through Spearman correlation analysis,we found that sST2 was positively correlated with plasma prothrombin time(r=0.257,P<0.001),blood lactate value(r=0.297,P<0.001),PCT(r=0.438,P<0.001),NT-proBNP(r=0.377。P<0.001),SOFA score(r=0.338,P<0.001),APACHE Ⅱ score(r=0.289,P<0.001),and SAPS Ⅱ score(r=0.282,P<0.001).However,sST2 was negatively correlated with platelet(r=-0.266,P<0.001),albumin(r=-0.168,P=0.002),eGFR(r=0.233,P<0.001),and left ventricular ejection fraction(r=-0.192,P<0.001).4.According to ROC analysis,sST2,SOFA score,APACHE Ⅱ score and SAPS Ⅱ score have certain predictive value for 28 day mortality,among them,APACHE Ⅱ has the highest predictive value for sepsis patients(AUC=0.796,P<0.001),but the specificity is low(58.7%).Compared with APACHE Ⅱ score,SAPS Ⅱ score has a lower predictive value(AUC=0.765,P<0.001),but it has a higher sensitivity(70.1%)and specificity(74.1%).After adding sST2 into the joint prediction of the three severity scoring systems,the prediction performance was significantly improved.Among them,APACHE Ⅱscore+sST2 had the highest predictive value(AUC=0.823,P<0.001),and its sensitivity(80.5%)and specificity(72%)were both outstanding.5.According to ROC analysis,both sST2,blood lactic acid and PCT have certain predictive value for the occurrence of 28-day mortality events.The predictive value of blood lactic acid(AUC=0.727,P<0.001)is higher than that of sST2(AUC=0.695,P<0.001)and PCT(AUC=0.670,P<0.001).The diagnostic specificity of blood lactic acid(49.7%)and PCT(40.7%)was lower.The specificity was improved after sST2 added to the combined diagnosis,and their prediction performance has also increased to different degrees.6.In univariate logistic regression,ALL three forms of sST2(sST2,whether it is beyond the median:92.3(ng/mL),and whether it is beyond the best cut-off point of ROC curve:113.8(ng/mL))can be regarded as the risk factors for 28-day mortality events of sepsis patients.The increase of serum sST2 is significantly related to the increase of the risk of death(all P<0.001).7.In multivariate logistic regression analysis,we found that septic shock,blood lactate level,sST2 level,APACHE Ⅱ score can still be regarded as an independent risk factor leading to 28-day mortality in patients with sepsis(all P<0.05)after adjusting covariates as septic shock,mechanical ventilation,platelet,albumin,plasma prothrombin time,blood lactate,procalcitonin,troponin I,NT-proBNP,sST2,left ventricular ejection fraction,SOFA score,APACHE Ⅱ score and SAPS Ⅱ score.Conclusions:1.The level of sST2 can reflect the severity of sepsis.With the increase of the level of sST2,many indicators of patients tend to worsen and the score of the severity scoring system increases.2.SOFA score,APACHE Ⅱ score and SPAS Ⅱ score have certain predictive ability for the short-term prognosis of patients with sepsis.The combination of sST2 can greatly improve the predictive value.3.The predictive value of sST2 level for short-term prognosis of sepsis patients is lower than that of blood lactic acid,but the advantage is that the specificity is relatively higher.The combination of multiple biomarkers can improve the overall clinical value.4.Patients with high levels of sST2 have a higher risk of death,Septic shock,high blood lactate level,high level of sST2,and high APACHE Ⅱ score are independent risk factors of mortality in patients with sepsis. |
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