The Correlation Of Howell-PIRO Model And TCM Syndrome Differentiation And Prognosis For Elderly Patients With Sepsis

ObjectiveTo investigate the correlation between the Howell-PIRO score and the severity and prognosis of elderly patients with sepsis hospitalized in ICU.Comparison of the scores of Howell-PIRO model,APACHE? scoring system and SOFA scoring system,to explore their ability in predicting mortality for elderly patients with sepsis.By using the recommended syndrome differentiation method of the Expert Consensus on Diagnosis and Treatment of Integrative Medicine for the Patients With Sepsis,we try to investigate the law of TCM Syndrome pattern and the correlation between TCM Syndrome pattern,severity and prognosis of elderly patients with sepsis.MethodsThis subject through retrospective study,to elderly patients with sepsis as the object of study.We collected datas such as age,gender and other basic information,past medical history,history of present illness,the condition of hospitalization of this time,results of auxiliary examination and diagnostic information of TCM.After that,we count out the scores of Howell-PIRO model,APACHE II scoring system and SOFA scoring system.Statistical analysis using SPSS statistical software.We drew the Receiver Operating Curve(ROC),compared the Area Under the Curve(AUC),sensitivity,specificity and the optimal cut-off value of Howell-PIRO model,APACHE II scoring system and SOFA scoring system,so as to evaluate the prognostic value for elderly patients with sepsis.We also compared the severity and prognosis of different TCM Syndrome pattern,and used the method of correlation analysis to analyze the correlation.Results1.154 cases of elderly patients with sepsis were divided into sepsis group(n=18),severe sepsis group(n=101),septic shock group(n=35)according to the severity of the disease.According to TCM Syndrome pattern,154 cases were divided into Evil Poison Attack Lung Syndrome in 72 cases,Yang Qi Collapse Syndrome in 42 cases,Heat Toxin Syndrome in 24 cases,and 16 cases of Colon Heat Fu Syndrome.With twenty-eight days as observation point,there were 119 cases survived and 35 cases died,among which there were 21 cases in Yang Qi Collapse Syndrome,11 cases in Evil Poison Attack Lung Syndrome,2 cases in Colon Heat Fu Syndrome and 1 cases in Heat Toxin Syndrome.The twenty-eight days mortality rate of different severity and TCM Syndrome pattern were statistically significant(P<0.01).2.Comparison of Howell-PIRO scores in elderly sepsis patients with different prognosis:The death group(18.71±4.04)was higher than the survival group(12.66 ± 3.55),By the independent sample t test,the difference was statistically significant(t?8.577,P<0.01).And with the increase of Howell-PIRO score,the mortality rate increases.The correlation coefficient between Howell-PIRO model and prognosis was r=0.542(P<0.01)3.Comparison of Howell-PIRO scores in elderly sepsis patients with different severity:Septic shock was the highest(14.04 ± 4.45),and the severe sepsis group(13.29±3.29),sepsis group(9.00 ± 2.72)were followed by.By the Analysis of Variance,there was significant difference between the groups(F= 57.118,P<0.01).The correlation coefficient between Howell-PIRO model and disease severity was r=0.636(P<0.01).4.Comparison of Howell-PIRO scores in elderly sepsis patients with different TCM Syndrome pattern:The Yang Qi Collapse Syndrome(14.04 ± 4.45)was higher than Evil Poison Attack Lung Syndrome(13.14±3.13),Heat Toxin Syndrome(12.08 ± 3.97)and Colon Heat Fu Syndrome(10.56±3.78).By the Analysis of Variance,there was significant difference between the groups(F=24.944,P<0.01).The correlation coefficient between Howell-PIRO model and TCM Syndrome pattern was r=0.321(P<0.01).5.There were positive relevance between the Howell-PIRO model,APACHE II scoring system and SOFA scoring system(P<0.01).The AUC of Howell-PIRO model was 0.872(95%CI 0.803?0.941),the optimal cut-off value was 16.5,its sensitivity was 0.714,and specificity was 0.891.The AUC of APACHE?scoring system was 0.738(95%CI 0.645?0.831),the optimal cut-off value was 14.5,its sensitivity was 0.829,and specificity was 0.521.The AUC of SOFA scoring system was 0.794(95%CI 0.710?0.878),the optimal cut-off value was 6.5,its sensitivity was 0.629,and specificity was 0.807.Conclusion1.The scores of Howell-PIRO model were correlated with the severity and prognosis of elderly patients with sepsis,and the higher the score,the more severe the disease,the worse the prognosis2.Howell-PIRO model has good predictive value on the prognosis of elderly patients with sepsis,its effectiveness was better than APACHE? scoring system and SOFA scoring system.Its specificity is superior to the APACHE?scoring system and SOFA scoring system,and sensitivity is superior to SOFA score system.3.Different TCM Syndrome pattern in elderly patients with sepsis has different severity and different prognosis,and the Yang Qi collapse syndrome has the worst severity and prognosis.4.There is a positive correlation between TCM syndrome differentiation and Howell-PIRO model,and the combination of the two methods can better help to evaluate the severity and prognosis of elderly patients with sepsis.