The Hematocrit And Plasma Albumin Levels Difference Can Be Used In The Feasibility Study On The Differential Diagnosis Of Hemorrhagic Shock And Septic Shock

Objective: Exploring the hematocrit and plasma albumin levels difference in both hemorrhagic shock and septic shock. With the correlation between them, we aim to provide a quick and simple method for clinical diagnosis,and use it in differential diagnosis of distributive shock and non-distributive shock.Methods: Selecting 113 samples of hemorrhagic shock and 103 samples of septic shock from patients with shock accepted by department of critical care medicine and emergency department through the year of 2016. Based on the discharge diagnosis,the patients were divided into groups of hemorrhagic shock and septic shock. At the same time, from The Yunnan Kunming Medical Center we selected 5000 people who took the healthy examinations as comparation. All the cases were recorded about the hematocrit(HCT) and serum albumin(ALB) measured without blood products infusion on the first day of onset, what were also recorded were heights and weights when the cases entered hospital. The data above were compared in different groups.Then we calculated the level differences (HCT-ALB) between hematocrit(HCT) and serum albumin(ALB), and we analyzed how thedifferences differed in the groups of hemorrhagic shock, septic shock and the comparation, and sought the most ideal diagnostic value.Results: 1. We compared the group of hemorrhagic shock with the group of septic shock in gender and body mass index(BMI). As a result, no statistical significance was showed in the differences between two groups(P>0.05), and no difference between two groups mentioned, which proved that. 2. When comparing the group of hemorrhagic shock with the group of septic shock, the level differences (HCT-ALB)had statistical significance(P=0.000,P<0.05),which showed the the level differences(HCT-ALB) in the group of hemorrhagic shock and the group of septic shock differs a lot. Also, the level differences(HCT-ALB) was apparently lower in the group of hemorrhagic shock than in the group of septic shock. When comparing the group of hemorrhagic shock with the groups of normal subjects, the level differences(HCT-ALB) has statistical significance(P=0.000,P<0.05), which showed there's obvious differences in the level differences(HCT-ALB) in the group of hemorrhagic shock and the groups of normal subjects, and the level differences(HCT-ALB) was lower in the group of normal subjects than in the group of hemorrhagic shock. When comparing the group of septic shock with the groups of normal subjects, the level differences(HCT-ALB) has statistical significance(P=0.000,P<0.05), which showed which showed the the level differences(HCT-ALB) in the group of septic shock and the group of normal subjects differs a lot.3, by drawing the receiver operating characteristic curve (ROC),we could see the area under curve(AUC) was 0.887. which showed it is of high accuracy by diagnosing hemorrhagic shock and septic shock with the level differences (HCT-ALB).Corresponding standard error is 0.024,P=0.000,95% of confidential interval are(0.840, 0935). 4, by calculating index of positive likelihood ratio, we selected 13.55 as the most ideal diagnostic value, with sensitivity (41.7%) and specificity(99.1%) at this cut off value.Conclusions: 1. The level differences(HCT-ALB) differs from normal subjects group, hemorrhagic shock group to septic shock. 2. The shorter prehospital time patients have, the better effects the level differences (HCT-ALB) method will have. 3.If the the level differences(HCT-ALB) is higher than 13.55, we can nearly diagnose the patient septic shock, with sensitivity (41.7%) and specificity (99.1%) at this cut off value. 4. In the process of diagnosis, associated hemophagocytic syndrome (HPS)must be looked for, be ware if it is compound shock, if the patients has been in major trauma or operations, and if COPO, nephrotic syndrome, dysfunction of liver protein synthesis or malnutrition exist.