Study On The Correlation Between Onodera’s Prognostic Nutritional Index And Prognosis Of Sepsis

Objective:1.To explore the correlation between Onodera’s prognostic nutritional index(OPNI)and the prognosis of patients with sepsis.2.To explore the pathogenic bacteria distribution,prognosis and clinical characteristics of septic patients with blood culture positive in intensive care unit(ICU,EICU).Methods:Retrospective collection of case data of sepsis patients hospitalized in ICU and EICU of Inner Mongolia Medical University Affiliated Hospital from January 2012 to October 2022.130 sepsis patients were selected according to the inclusion and exclusion criteria of the project,and the 28 day survival status of the patients was followed up.Based on whether the patients survived for 28 days,the patients were divided into alive group and death group.The differences in general clinical data,laboratory data,and clinical scores between the two groups were compared,Analyze the correlation between OPNI and the prognosis of sepsis patients.Draw the subject work characteristic curves of OPNI,Sequential Organ Failure Assessment(SOFA),Acute Physiology and Chronic Health Evaluation(APACHE II),OPNI combined SOFA score,and OPNI combined APACHEII score,calculate the area under the curve(AUC),and compare the value of OPNI in prognosis evaluation of sepsis patients.Calculate the optimal cutoff value of OPNI based on the Jordan index,and divide sepsis patients into low-risk and high-risk groups with the optimal cutoff value as the boundary.Compare survival rates used the Kaplan Meier survival curve.Based on the results of pathogen culture,patients with sepsis were divided into blood culture positive and negative groups.The distribution of pathogens in the blood culture positive group of sepsis patients was analyzed,and the differences in clinical data,laboratory data,and clinical scores between the two groups were compared.The prognosis and clinical characteristics of blood culture positive sepsis patients were analyzed.The calculation formula for OPNI is:serum albumin concentration(g/L)plus 5 times lymphocyte count(10~9/L).Results:At 28 days of follow-up,47 patients(36.15%)died.Compared with the patients in the survival group,the patients in the death group were older,had more cases of glycuresis,heart cerebrovascular diseases,and chronic respiratory diseases,had lower serum albumin concentration and lymphocyte count,and had higher hematocrit,lactate dehydrogenase,SOFA score,and APACHEⅡscore.The differences were statistically significant(P<0.05).The difference in OPNI between the two groups of patients was statistically significant in univariate analysis and binary logistic regression analysis(P<0.05),indicating that OPNI was an independent risk factor for 28 day mortality in sepsis patients,and the risk of death in sepsis patients with OPNI<33.53 is 7.117 times higher than that in sepsis patients with OPNI≥33.53.The ROC curve results show that the area under the curve for OPNI,SOFA score,APACHEII score,OPNI combined SOFA score,and OPNI combined APACHEII score were0.672(95%CI:0.573-0.770,P=0.001),0.775(95%CI:0.689-0.860,P<0.001),0.827(95%CI:0.752-0.903,P<0.001),0.811(95%CI:0.735-0.887,P<0.001),and 0.869(95%CI:0.752-0.902,P<0.001),respectively.The optimal cutoff value for OPNI calculated based on the Jordan index was 33.53.With OPNI=33.53 as the boundary,patients were divided into a low-risk group(OPNI≥33.53)and a high-risk group(OPNI<33.53).The Kaplan Meier survival curves of the two groups showed that the cumulative survival rate of the low-risk group is significantly better than that of the high-risk group,with a statistically significant difference(P<0.001).Among 130 patients with sepsis,a total of 73(56.15%)showed positive results in pathogen blood culture,including 50 strains of Gram negative bacteria(68.49%),18 strains of Gram positive bacteria(24.66%),and 5 strains of fungi(6.85%).The top four Gram negative bacteria in the rankings are Escherichia coli(24.66%),Klebsiella pneumoniae(16.44%),Acinetobacter baumannii(13.70%),and Klebsiella acidogenes(6.85%).The top three Gram positive bacteria were Staphylococcus aureus(9.59%),Enterococcus(5.48%),and Staphylococcus hominis(2.74%).Fungi include 2 tropical Candida strains(2.74%),2 white Candida strains(2.74%),and 1 smooth Candida strain(1.37%).Compared with sepsis patients in the blood culture negative group,sepsis patients in the blood culture positive group had faster heart rate,more cases of previously diagnosed diabetes and chronic respiratory diseases,higher APACHEII score and SOFA score,lower OPNI value and platelet count(P<0.05).Compared with the sepsis patients in the blood culture negative group,the age,body temperature,respiratory rate,mean arterial pressure,WBC,NEU,CRP,PCT,and 28 day mortality of the sepsis patients in the blood culture positive group were higher,and the HGB was lower,but the difference was not statistically significant(P>0.05).Conclusion:1.OPNI was independently associated with 28 day mortality in sepsis patients,and was a good predictor of 28 day mortality in sepsis patients.The risk of death in sepsis patients with OPNI<33.53 was 7.117 times higher than in sepsis patients with OPNI≥33.53.2.The pathogen distribution of sepsis patients in the blood culture positive group was mainly Gram negative bacteria,with Escherichia coli being the most common.Compared with the sepsis patients in the blood culture negative group,the sepsis patients in the blood culture positive group had faster heart rate,more cases of previously diagnosed diabetes and chronic respiratory diseases,higher APACHII score and SOFA score,and lower OPNI value and PLT.There was no significant difference in 28 day mortality between the two groups of patients.