A Comparison Of The Value Of Related Biomarkers And Scoring Systems To Assess The Severity And Prognosis For Patients With Sepsis

Objective To investigate the power of variety of biomarkers and scoring systems in predicting the severity and prognosis in patients with sepsis.Methods A retrospective study was conducted. A total of 195 sepsis patients who were treated in the Emergency Medicine Department of Tianjin Medical University General Hospital from July 2013 to December 2014 were enrolled, and collected the basic vital signs of all cases,white blood cell(WBC),Procalcitonin(PCT),C-reactive protein(CRP),D-Dimer and other clinical and laboratory variables that were tested in the first 24-hour. The Acute Physiology and Chronic Health Evaluation score?(APACHE?), Sequential Organ Failure Assessment score(SOFA), Simplified Acute Physiology Score?(SAPS?), Mortality in Emergency Department Sepsis score(MEDS),Modified Early Warning score(MEWS)and Rapid Emergency Medicine Score(REMS) were calculated by two docters respectively and take the average. According to the result after they entered into the observation of 28 days and then they were divided into surivival and death group,WBC, PCT, CRP, D-Dimer and APACHE?score, SOFA score,SAPS?score, MEDS score,MEWS score,REMS score were compared respectively between the two groups. These predictors which can independented in predicting the 28-day mortality was getermined by the Logistic regression analysis.The receiver-operating characteristic(ROC) curve(AUC) was used to compare the independent variable's ability in predicting the results. Then the patients were divided into the sepsis group and severe sepsis group(including septic shock)according it's severity level. WBC, PCT, CRP, D-Dimer and APACHE?score,SOFA score,SAPS?score, MEDS score,MEWS score,REMS score were compared respectively between the two groups,and which predictor can be the independent predictor was determined by the Logistic regression analysis. The AUC was used to compare the independent variable's ability to predict the results. The correlation between these biomarkers and scoring systems with APACHE ? score was calculated.Result(1) The total mortality was 14.36% of the 195 patients within 28 days.(2)Compared with surivival group, the patients in the death group was older and withhigher PCT, D-Dimer, APACHE?score, SOFA score, SAPS?score, MEDS score,MEWS score, REMS score(P<0.05), there was no difference in the WBC and CRP between the two groups(P>0.05). The death group patients had higher ratio of lung and urinary system infection, and higher ratio of underlying diseases that was cardiovascular disease and diabetes mellitus(P<0.05).It was identified by logistic regression that the significantly independent factors that can predict the 28-day death in these patients were the APACHE?score and SOFA score(P<0.05). The AUC were0.773, 0.759 for APACHE?score and SOFA score respectively.(3) Compared with sepsis group, the patients in the severe sepsis group with higher PCT,D-Dimer,APACHE?score, SOFA score, SAPS?score, MEDS score and MEWS score(P<0.05), there was no statistical differences between the two group in WBC,CRP and REMS score(P>0.05).The SAPS?score and MEDS score were the significantly independent factors of severity prediction in patients with sepsis(P<0.05). The AUC were 0.748,0.712 for MEDS score and SAPS?score respectively.(4)The CRP, PCT,D-Dimer, SOFA score, SAPS?score, MEWS score, MEDS score and REMS score were positively correlated with APACHE?score(P<0.05), and but the WBC was no correlation with it(P > 0.05).Conclusions(1) The APACHE?score,SOFA score, SAPS?score,MEDS score and MEWS score are increased along with the risk of death and disease severity increases,and the REMS score is increased along with the risk of death but do not reflect the severity of the sepsis patient.(2)The APACHE?score and SOFA score can separately predict the 28-day death prognosis of patients with sepsis, and the predict capacity are considerably.(3) MEDS score and SAPS ? score are the significantly independent predictors of severity prediction in patients with sepsis, and the predict capacity are considerably.(4)The PCT and D-Dimer levels are increased along with the risk of death and disease severity increases, and they are positively correlated with APACHE?score, but not the independent predictor of the severity and prognosis of patients with sepsis.The WBC and CRP are not increased along with the risk of death and disease severity increases.