| Objective:The hemostasis abnormality is the important reason which causing death in sepsis.In our study, we analyzed the relationship between the changes of plasma antithrombinⅢ(AT-Ⅲ) and protein C (PC) level and the severity as well as the prognosis of the disease in patients with sepsis.Methods:160patients (sex:male87,female73;age:64.0±17.6y) were recruited in ICU of Qilu Hospital from July2010to December2011.AT-Ⅲ、PC、PCT、CRP、 APACHE Ⅱ score and SOFA score were recorded in the first day of hospitalization. Then, AT-Ⅲ and PC were reviewed in the third day of hospitalization. The patients were divided into3groups according to the level of plasma AT-Ⅲ:Al group (AT-Ⅲ>80%)、A2group (40%<AT-Ⅲ<80%) and A3group (AT-Ⅲ<40%). The28-day mortality among the three groups was compared in this study. In addition, the patients were divided into3groups according to the level of plasma PC:P1group (PC>80%)、P2group (40%<PC<80%) and P3group (PC<40%). The28-day mortality among the three groups was compared in this study. The patients were divided into3groups according to the severity of sepsis:S1group (sepsis)、S2group (severe sepsis) and S3group (septic shock), and the level of AT-Ⅳ and PC among the three groups was compared in this study. The patients were divided into2groups according to the APACHE Ⅱ sccore:less than20group and more than20group, and the level of AT-Ⅲ and PC between the two groups was compared in this study. Furthermore, according to the level of AT-Ⅲ and PC in the third day decreasing or not when campared to the first day, we divided into2groups, and the28-day mortality between two groups was compared in this study. At last, the patients were divided into survival group and death group, the level of AT-Ⅲ and PC between the two groups was compared in this study.Results:1.The28-day mortality of A2group was significantly higher compared to A1group (28.99%vs21.82%, P<0.05). The28-day mortality of A3group-was significantly higher compared to both A1group and A2group (44.44%vs21.82%, P<0.001;44.44%vs28.99%, P<0.001)2.The28-day mortality of P3group was significantly higher compared to both PI group and P2group (46.43%vs22.58%, P<0.05;44.44%vs30.00%, P<0.05).3. The levels of AT-Ⅲ of S2group and S3group were significantly lower compared to S1group (83.7±22.8vs90.8±21.2, P<0.05;68.9±25.1vs90.8±21.2, P<0.05). The levels of PC of S2group and S3group were significantly lower compared to S1group (69.5±19.7vs78.2±30.8, P<0.05;70.3±27.4vs78.2±30.8, P<0.05). The levels of AT-Ⅲ of S3group were significantly lower compared to S2group (68.9±25.1vs83.7±22.8, P<0.05), but no difference was observed when it comes to PC level.4. There was a significant difference of AT-Ⅲ level between APACHE Ⅱ≤20patients and APACHE Ⅱ>20patients (69.31±22.32vs74.66±24.68, P<0.05;69.31±22.32vs71.95±29.04, P<0.001). Moreover, a positive relationship was found between PC level and APACHE Ⅱ score.5. No significant difference of28-day mortality was found between lower level of AT-Ⅲ as well as PC and not lower group (50%vs11.11%, P<0.001;41.18%vs23.80%, P<0.001).6. The levels of AT-Ⅲand PC of death group were significantly lower compared to survival group (61.46±25.18vs72.31±19.62, P<0.05;54.48±17.41vs76.19±8.99, P<0.05).7.The area under the ROC curve of prediction in patients with sepsis deaths were0.539、0.565、0.682、0.682, and no significant differences between the four groups. When AT-Ⅲ taking66.5%as the cutoff value, the sensitivity was52.4%, specificity of62.1%; When the PC taking49.5%as the cutoff value, the sensitivity was38.1%, specificity of81.6%.Conclusion:The levels of AT-Ⅲ and PC were significantly decreased in patients with sepsis, which had association with the prognosis of sepsis patients;, The dynamic changes of the AT-Ⅲ and PC can predict the prognosis of patients, and the patients undergoing no improvement of AT-Ⅲ and PC after treatment had a higher mortality. Sepsis patients with other non-infectious diseases could have some impact on AT-Ⅲ and PC level. |
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