Analysis Of Clinical Parameters In Mortality Prediction Of Patients With Septic Shock

BACKGROUNDSepsis is SIRS in patients with a documented infection. Septic shock is severe sepsis stage complicated by acute failure of cardiovascular with intractable hypotension, which can progress to MODS or MOF. It has been reported that mortality of sepsis was 15%-45%, and the mortality of septic shock was 40%-60%.The pathophysiology of septic shock and MODS are very complex. There are many theories such as Infection Theory,Macrophage Theory.Intestine Theory,Microcirculation Theory and Out-of-balance of Inflammation Theory, which make progress understanding of the pathophysiology of septic shock and MODS. Although the rescuing methods of septic shock and MODS have been developed constantly, the outcome has still been poor and the incidence of them has still beenhigh. Therefore it is important to have the early prognosis of septic shock and MODS and give the early presentation treatments, which is the key to lower the mortality of sepsis now. So there are too many studies about the prognosis of septic shock and MODS all over the world.At present, we still use the ACCP/ SCCM standard in 1992 to classify the severity of sepsis, including Sepsis,Sever sepsis,Septic shock and MOF. The standard gives much help to sepsis research for its definite declines and compact criteria, but it has much limit to clinical use for some loosen criteria and large diagnosis scope. The Acute Physiological Chronic Health Evaluation Scoring System (APACHEII,III) and Sequential Organ Failure Assessment Scores (SOFA) are used in sepsis research for their definited prognosis of outcome and death risk, but also have limitation in clinical uses. The reasons are included: 1. Some risk factors such as sex,age,history are out of control of doctors or patients which make inclined therapy. 2. They are emphasized to an aspect or a phrase evaluation of diseases without a dynamic evaluation, which ignore the development of septic shock and MODS. 3. Most of indexes can not be used to guide the treatment according to death risk. For example, they do not provide the different treatment between the patients with 20% death risk and 50% death risk. So they can not be used to assess the individual risk. Therefore we need combine many standards to provide a more precise direction in research and clinical works that can guide the therapy of septic shock and MODS and lower the incidence and mortality. In order to find a compact,microtraumatic and dynamic standard that can exactly prognose the development and outcome of septic shock, we have carried out this research.OBJECTAccording to a retrospective study of patients with septic shock, we studied the early indexes and outcome of these patients and got some clinical indexes that can provide a certain clinical direction to the monitor and rescue of septic shock and MODS and also provide a certain reference to large scale clinical research.METHOD1. A total of 125 patients, 91 males and 34 females with main age of 68.8±5.4, participated in our study. These patients admitted to ICU of Sir Run Run Shaw Hospital from Jan. 2000 to Jan. 2005 according to the diagnosis criteria of septic shock, including pulmonary infection46 cases, abdomen infection 44 case, wound infection 22 cases and other infection 13 cases. On the base of survival condition for 28 days, they were classified by survival group (67 cases, 53.6%) and death group (58 cases, 46.4%).2. Study the survival condition of patients at the 1st day (D1),the 3rd day (D3),the 5th day (D5),the 7th day (D7) and the 28th day. Select indexes from patient intensive care flowsheet,patient graphic fliud balance record,patient lab summary, including history,treatment condition,in- and out-fluid; vital signs (CVP,SBP,MAP,HR,RR,T); lab reports (CBC,ABG,CX7,culture report) and imaging record. The levels of serum proprocalcitonin (PCT) were specially measured at in 42 patients at D1,D3,D5,D7.3. The measurement of PCT was by rapid immune chromatography. Five ml of blood samples were obtained from the vein and were centrifugated for 5 mins at room temperature. 200 ul superna...