Clinical Study On The Diagnostic Value Of HBP?PCT?CRP?LAC?WBC In Sepsis

ObjectiveTo detect the expression of plasma heparin-binding protein,procalcitonin,leukocyte,C-reactive protein and Lactic acid in patients with sepsis,non-sepsis infection in intensive care unit and healthy subjects in our hospital.through comparative analysis of various indicators,to explore the clinical application value of quantitative detection of each indicator in sepsis diagnosis,severity assessment.MethodsA total of 60 patients diagnosed as sepsis in the Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from October 2016 to February 2018were selected.The diagnostic criteria for sepsis were based on the criteria set out in the third international consensus.According to the Society of Critical Care Medicine,the“Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016”will be divided into sepsis non-shock group?n=38 cases?and septic shock group?n=22 cases?.In addition,25 healthy patients who passed the age and sex match in the physical examination department of our hospital were selected as the healthy control group.In the same period,31 cases of the non-sepsis common infection group were used as the infection group.The level of heparin-binding protein?HBP?in each subject was determined by enzyme-linked immunosorbent assay,and C-reactive protein?CRP?,Lactic acid?LAC?,procalcitonin?PCT?and white blood cell?WBC?levels in each subject were measured simultaneously,while collecting the age,sex,hospital number,underlying disease,acute physiology and chronic health evaluation?APACHE II?and sequential organ failure assessment?SOFA?and other general information.Statistically compare the differences between the above indicators in each group;establish the receiver operator characteristic curve?ROC curve?and calculate the area under the ROC curve(AUC^ROC)to analyze the diagnostic value of each index for sepsis patients to find the best cut-off value,analyze and compare the sensitivity,specificity,positive predictive value and negative predictive value of HBP,PCT,CRP,LAC,WBC in the diagnosis of sepsis,and analyze the correlation between the indicators.ResultsThe levels of HBP in plasma of healthy control group,infected group,sepsis non-shock group and septic shock group were 3.64±1.72,41.13±28.82,86.72±56.16,and 144.76±104.11?ng/ml?,respectively.There was a statistically significant difference between any two groups?P<0.05?.The PCT levels in plasma of healthy control group,infected group,sepsis non-shock group,and septic shock group were0.03±0.02,3.18±4.47,7.87±11.83,and 34.56±27.53?ng/ml?,respectively.There was no significant difference between sepsis non-shock group and infected group?P>0.05?.There are statistical differences between the remaining groups?P<0.05?.The WBC levels in plasma of healthy control group,infected group,sepsis non-shock group and septic shock group were 5.71±2.00,13.43±6.54,16.97±7.82,19.39±17.93?×10⁹/L?,respectively.There was no significant difference between sepsis non-shock group and infected group?P>0.05?.There was no significant difference between sepsis non-shock group and septic shock group?P>0.05?.There are statistical differences between the remaining groups?P<0.05?.The levels of CRP in plasma of healthy control group,infected group,sepsis non-shock group and septic shock group were 5.84±8.93,85.86±36.72,122.07±83.96,and 150.03±146.35?mg/L?,respectively.There was no significant difference between sepsis non-shock group and septic shock group?P>0.05?.There are statistical differences between the remaining groups?P<0.05?.The levels of LAC in plasma of healthy control group,infected group,sepsis non-shock group and septic shock group were 1.13±0.73,1.83±1.36,3.05±2.28,and 4.82±3.43?mmol/L?,respectively.There was no significant difference between infected group and healthy control group?P>0.05?,and there are statistical differences between the remaining groups?P<0.05?.ROC curve analysis showed that compared with other indicators,the AUC^ROC of HBP was the highest,which was 0.872.When the HBP cutoff value was 24.1 ng/ml,the sensitivity and negative predictive value of diagnosis of sepsis were the highest,88.3%and 84.8%,respectively.The sensitivity?90.0%?increased when sepsis was diagnosed with HBP>24.1 ng/ml or PCT>24.2 ng/ml.Linear correlation analysis revealed that plasma HBP was correlated with other indicators in all subjects?P<0.05?.There was a correlation between WBC and LAC?r=0.531,P=0.011?in the septic shock group.In the infected group,there was a correlation between PCT and LAC?r=0.561,P=0.001?.In the healthy control group,there was a correlation between CRP and LAC?r=0.646,P=0.000?.In all patients with sepsis?including sepsis non-shock group and septic shock group?,HBP was correlated with PCT,and the correlation was greatest?r=0.394,P=0.002?;PCT was correlated with CRP?r=0.288,P=0.026?;LAC was correlated with WBC?r=0.284,P=0.028?.In the sepsis non-shock group,the correlation analysis between the indicators showed that the correlation between the indicators was not statistically significant?P>0.05?.Conclusions1.The five indicators of HBP,PCT,WBC,CRP and LAC in the low to high levels in each group were healthy control group,infected group,sepsis non-shock group and septic shock group.2.The area under the curve of HBP diagnosis of sepsis was the largest.Compared with PCT,WBC,CRP and LAC,the sensitivity and negative predictive value of diagnosis of sepsis were the highest.3.Each indicator has a correlation in different groups and the difference is significant.HBP has the greatest correlation with the PCT,and combined detection of the two indicators can improve the diagnostic sensitivity.