Clinical Significance Of The Change Of PCT And Monitoring Arterial Blood Lactate And BE Of Sepsis

Objective To observe PCT, change of arterial blood lactate and BE for severity and the prognosis of septic patientsMethods All the observe subjects were selected from the admission patients of the EICU of Tianjin medical university general hospital,who aged23-87yr and average(63.88±14.20)yr.30cases of pneumonia, urinary tract infection in15cases,6cases of intestinal infection, liver abscess in4cases, other parts of the infection in15cases.40patients with sepsis aged23-86yr and30patients with severe sepsis aged45-87yr. The patients with sepsis and severe sepsis met sepsis criteria according to2001SCCM/ESICM/ACCP/AIS/SIS International Sepsis Definition Conference.We measured the arterial blood lactate and BE when admitted and after24h,48h, calculate24h,48h lactate clearance. At the same time Simultaneous monitoring of all patients with clinical and laboratory indicators, including gender, age, body temperature, breathing, heart rate, blood pressure, oxygen saturation, liver and kidney function, blood coagulation, blood examination and so on. We collected clinical variables in24hours, calculated APACHE Ⅱ score.According to the outcome, patients with sepsis were divided into survival group and non-survival group, then the detection data were compared. Application SPSS17.0software package for data processing, the normal distribution of quantitative data (x±s), the non-normal distribution of the data using the median (quartile range) that the groups were compared using t test or rank sum test, count data using the χ2test. Based on a single factor logistic regression analysis to define the risk factors, we performed the multinomial logistic regression analysis and found independent risk factors which had important effect on clinical. Meaningful indicators to draw the receiver operating characteristic curve (ROC curves) were calculated area under ROC curve of various indicators, to compare the sensitivity and specificity of the prognosis. Two variables associated with linear correlation analysis, relevance application of Pearson’s correlation coefficient analysis. P<0.05was considered statistically significant.Results APACHE Ⅱ score, PCT, arterial blood lactate level on admission to hospital of Severe sepsis group were higher than the sepsis group, but the BE level were lower, PCT0.49(1.63) ng/mL vs2.90(5.45) ng/mL,APACHE II score13.00(6.00) vs20.50(8.25), arterial blood lactate level2.55(1.38) mmol/L vs5.55(1.48) mmol/L,BE-6.80(4.43) mmol/L vs-8.55(6.20) mmol/L. APACHE II score, PCT, arterial blood lactate level on admission to hospital in dead group were higher than the survival group, PCT9.00(11.40) ng/mL vs0.49(1.62) ng/mL, APACHE Ⅱscore21.50(3.25) vsl4.00(7.75),arterial blood lactate level6.75(4.55) mmol/L vs2.27(1.30)mmol/L,but24h,48h arterial blood lactate clearance, BE level were lower,24h arterial blood lactate clearance13.39(16.97)%vs34.78(30.00)%,48h arterial blood lactate clearance (39.38)%vs62.96(24.73)%,BE-9.25(4.55) mmol/L vs-6.80(4.45) mmol/L.The value showed a linear positive correlation between PCT and arterial blood lactate level and APACHE II score, a linear negative correlation between PCT and BE. logistic regression analysis showed that24h lactate clearance, PCT,APACHE II score were risk factors for prognosis of patients with sepsis and under ROC cure of24h arterial lactate clearance and PCT was0.960, the sensitivity and specificity were higher.Conclusion1.The lactate clearance, PCT and BE are of significance in judging the severity of sepsis.2.The24h lactate clearance, PCT and APACHE II score are of significance in judging the prognosis of sepsis.