Clinical Signincance Of Early Monitoring Of Presepsin In Patients With Acute Trauma

Objective:To study the acute trauma patients with early sCD14-subtype (Presepsin) changes in the characteristics and factors associated with inflammation (CRP, PCT and WBC), the relationship between blood lactate and APACHE II score, evaluation of blood sCD14-subtype (Presepsin) Horizontal patients with acute traumatic sepsis associated with early diagnosis and determine the significance of the disease and defects.Methods: Tianjin Hospital ICU, acute trauma patients admitted in August2012and December2013a total of106cases, of which66patients with sepsis, and is set to traumatic sepsis group, ages19-86years, mean (43.08±17.15years old), male47cases, female19cases; according to final prognosis of patients with sepsis sepsis group will be divided into traumatic sepsis survival group (56cases) and sepsis death group (10cases); patients without sepsis in40cases, is set to a non-trauma sepsis group, age22-80years, mean (47.65±15.21years), including29males and11females; Tianjin Hospital while selecting the same period20cases of healthy people, is set to the healthy control group, age14-85years, mean (46.60±20.51years),10males and10females. All trauma patients admitted to hospital with acute clinical data were recorded, vital signs, etc., and on admission, blood samples were collected within lh sCD14-subtype (Presepsin), blood count (WBC), C-reactive protein (CRP), serum procalcitonin (secretions or wound drainage fluid specimens from bacterial culture PCT), arterial blood lactate (Lactate), liver function, kidney function, electrolytes, blood gas analysis, temperature greater than38.5℃by sacrificing blood culture and sensitivity, there is a clear infected wounds susceptibility. Detailed records of patients admitted to hospital within24h of clinical indicators while the worst based on clinical indicators of acute physiology and chronic health evaluation Ⅱ(acute Physiology and choronic health evaluation, APACHEII score). The healthy control group health check during a routine examination of the same, all specimens measuring blood sCD14-subtype (Presepsin). Sepsis group were traumatic, traumatic non-sepsis group and the healthy control group, sepsis and septic death group survival group comparative analysis of clinical data. Presepsin concentration submission Tianjin Medical University General Hospital emergency center determination, other appropriate indicators, such as blood, C-reactive protein, procalcitonin, electrolytes, liver function, kidney function, blood culture, wound secretions, such as Tianjin hospital clinical training by, biochemical, immunological or bacterial laboratory for testing; arterial blood gas analysis by the Tianjin hospital ICU for testing. Statistical information obtained by SPSS19.0statistical software for data processing, all data normality test. XS normal distribution measurement data, said the two groups were compared using t test, ANOVA test was used to compare the three groups; non-normal distribution of measurement data with the median (25th percentile,75th percentile) M (Q1, Q3), said the two groups were compared using Mann-Whitney U test. And other indicators calculated Presepsin correlation analysis and the results of the correlation analysis using Spearman’s correlation; according to the prognosis of patients with traumatic sepsis, univariate analysis to draw meaningful clinical indicators, these indicators and more meaningful Logistic regression analysis, the risk factors affecting the prognosis of patients with traumatic sepsis were analyzed. According to a comparative analysis of traumatic wound sepsis group and the non-sepsis group, drawing the receiver operating characteristic (ROC) curve, calculate the area under the curve analysis Presepsin other inflammatory markers for early diagnosis of sepsis in patients with traumatic value. With p<0.05was considered statistically significant.Results:(1) traumatic sepsis group, trauma non-sepsis patients and healthy control group, the difference among the three groups Presepsin level of statistical significance (P<0.05),(2) traumatic sepsis group comparison of non-trauma patients with sepsis patients hospitalized with sepsis early Presepsin, PCT, arterial blood lactate, APACHEⅡ score significantly higher than non-sepsis group, there were statistically significant (P<0.05); two other inflammatory markers CRP, WBC level, the difference was not statistically significant (P>0.05).(3) group died of sepsis survival compared with patients with sepsis, septic death in patients hospitalized early Presepsin, arterial blood lactate, APACHEⅡ score significantly higher than sepsis survivors group, the differences were statistically significant (P<0.05); two other inflammatory markers PCT, CRP, WBC level, the difference was not statistically significant (P>0.05).(4) Spearman’s correlation analysis showed that patients with sepsis on admission traumatic early Presepsin arterial blood lactate levels and APACHE Ⅱ scores were positively correlated (r values were0.423and0.530, P<0.05).(4) draw ROC curve traumatic sepsis group and non-invasive diagnosis of sepsis, inflammatory markers of sepsis each group, and calculate AUCROC. Prescience of the area under the ROC curve was0.994, the area under the curve was0.939PCT, CRP area under the curve was0.483, the area under the curve was0.699WBC, showing the sensitivity of Prescience is the highest.Conclusion:1, Presepsin traumatic early diagnosis of sepsis is a sensitive indicator of its sensitivity and specificity than traditional PCT, CRP, WBC and other inflammatory markers.2, traumatic sepsis patients admitted to hospital early Presepsin levels, blood lactate and APACHE Ⅱ score changes prompted critical illness associated with the degree of influence prognosis, Presepsin be assessed as an independent risk factor for prognosis of patients with sepsis.