Study On Risk Factors For Eldly Severe Sepsis/Septic Shock Patients

Background:To study on the risk factors for eldlysevere sepsis/septic shock patients.Methods:319patients of eldly severe sepsis/septic shock were divided into two groups:survival group(178patients)and dead group(141patients).The APACHE score,SOFA score,BNP,serum PCT levels and PCT clearance rate,Lactate levels and early lactate clearance rate were calculated or calculated.All the above clinical data were compared between two groups and the logistic regression was performed to identify the independent factors for prediction of mortality.The ROC curve for predicting the 28d mortality were analysed.Results:1.The 5d and 7d PCT levels,the 5d and 7d PCT clearance rate,SOFA score,BNP,Lactate levels and early lactate clearance rate,and mixed pathogen infection are all the independent factors for prediction of mortality.2.The area under the ROC curve is0.570,0.636,0.669 and 0.575for Lactate levels,early lactate clearance rate,SOFA score and BNP.The area under the ROC curve is 0.707 and 0.757 for PCT clearance at 5d and 7d.3.PCT7≥0.80 ng/mL、△PCT7<30%、SOFA≥7/Lac≥4.0 mmol/l、≥Lac6<10%can be used as independent predictors and to set up a new prognosis established scoring system.4.AUC area under the curve of new prognostic models to predict the death of 28 days is 0.814,when the cutoff value 5.5,sensitivity is 73.8%,specificity is 74.5%.5.6 According to the new prognostic model score,283 cases of elderly severe sepsis/septic shock patients was seperated into 3 risk stratifications:high-risk group is defined as 9-12 points,intermediate risk group is defined as 5-8 points,the low-risk group is defined as 0-4 points.Conclusions:1.The 28d-mortalitythe of eldly severe sepsis/septic shock patients associated to the 5d and 7d PCT levels,the 5d and 7d PCT clearance rate,SOFA score,BNP,Lactate levels and early lactate clearance rate,and mixed pathogen infection.2.Lactate levels,early lactate clearance rate,SOFA score and BNP are not accurate prognostic markers in the old patients with severe sepsis/septic shock.3.PCT clearance is a good prognostic marker in the old patients with severe sepsis/septic shock.4.PCT7≥0.80 ng/mL、△PCT7<30%、SOFA≥7、Lac≥4.0 mmol/l、△Lac6<10%can be used as independent predictors and to set up a new prognosis established scoring system,which has better predictive value for 28d death of the elderly severe sepsis/septic shock patients than SOFA score and APACHEII score.