The Study On The Value Of C-reactive Protein/albumin In Long-term Prognosis Of Patients With Septic Shock

Objective:Evaluate the role of CRP/ALB in predicting mortality in patients with septic shock.Methods:This is a retrospective study, according to the inclusion and exclusion criteria, 136 cases with septic shock from January, 2009 to June, 2014 admitted in EICU were selected.They were divided into survival group and dead group according to results of follow-up for90 days. General clinical data, hospitalization days, organ support data, APACHE II score,basic diseases, blood routine results, CRP, ALB and other laboratories two groups were recorded and the ratio of CRP/ALB is computed. SPSS 19 statistical analysis was performed using the statistical software, to determine the relation of biomarkers and prognosis of patients.Results:1. This study collected 136 patients with septic shock, of which 58 cases were dead within 90 days after discharge, 78 cases were survival. The mortality rate was 42.7%.2. The mean age of patients in the dead group was 73.1 + 17.1 years while 68.6 + 17 years in the survival group, P< 0.001. APACHE II score is 30.4 in the dead group while in the survival group is 23.1, P< 0.001. There is no significant difference in the sex and the time of hospitalization between the two groups.3. In the dead group, There are six cases with chronic obstructive pulmonary disease, and four patients in the survival group, P<0.001. Five cases with chronic liver diseases in dead group, three patients in the survival group, P =0.024. Nine cases with tumor in dead group and 8 cases in survival group, P< 0.001.4. There are 31 cases with mechanical ventilation in dead group, 30 patients in the survival group, P=0.013. Nine cases with renal replacement therapy were in dead group, 6 patients in the survival group, P< 0.001. 41 cases with vasoactive drugs were in dead group, 40 patients in the survival group, P=0.015.5. Make analysis of white blood cells, hemoglobin, platelet count, admission and discharge of ALB, CRP value, and the ratio of CRP/ALB, etc. Single factor analysis showed that CRP/ALB dis and CRP dis were significantly associated with 90-day mortality in patients. The AUC of CRP /ALB dis and CRP dis were high and specificity is also high to predict 90-day mortality of patients after dischare from hospital, P=0.043.6.Correlation analysis showed that the coefficient between age over 65 years old in the dead group with the CRP dis is 0.293, r=0.293, P=0.048,associated with CRP/ALB dis is 0.314, r=0.314, P=0.033. The coefficient between complications over three in dead group and CRP dis is 0.550, r=0.550,P=0.046,associated with CRP/ALB dis is 0.511,r=0.511,P=0.036. The coefficient between APACHE II score and CRP/ALB dis is 0.406,r=0.406,P=0.014,correlated with CRP dis is 0.278,r=0.278,P=0.036. The coefficient between more than two organ support and CRP dis is 0.377, r=0.377,P=0.023,associated with CRP/ALB dis is 0.349, r=0.346,P=0.039.Conclusion:CRP dis and CRP/ALB dis play a diagnostic role in prediction of mortality of patients discharged from hospital after 90 day, and the CRP /ALB dis is more valuable. CRP /ALB dis can be used as indicator of long-term prognosis in patients with septic shock. Among patients with 65 years of age or older, APACHE II score more than 21 points, more than 3 comorbidity and more than two organs support therapy,CRP dis and CRP/ALB dis play more important role in prediction of prognosis of 90-day outcomes in septic shock patients. Age, APACHE II score were risk factors of 90-day mortality in patients with septic shock.