Diagnostic Value Of SIRS Score Combined With PCT For HBV-related Acute-on-chronic Liver Failure Complicated With Bacterial Infection

Objective:To investigate the diagnostic value of SIRS score combined with PCT in patients with bacterial infection by retrospective analysis of hepatitis B virus-associated acute-on-chronic liver failure patients,so as to improve the diagnostic ability of clinicians to detect bacterial infections of HBV-ACLF.Methods:A total of 219 hospitalized patients with HBV-ACLF were enrolled from January 2015 to June 2018 in the Department of Infectious Diseases,Affiliated Hospital of Southwest Medical University.219 patients were divided into infected group(n=150)and non-infected group(n=69)according to whether they were bacterial infected.Collect general information of all patients such as age,gender,etc.The first indicators within 24 hours of admission,such as vital signs,blood routine,C-reactive protein(CRP)count,PCT level,liver and kidney function,coagulation function,fasting blood glucose level,electrolyte level,etc,the main complications were collected for all patients.Patients were assessed for ACLF staging and SIRS score was calculated.The K-S test was used to analyze the frequency distribution of the samples.The t-test was used to compare the data of the normal distribution data group;the rank sum test was used to compare the data of the non-normal distribution data group;the categorical variable was analyzed by chi-square test;the grade data was analyzed by rank sum test.Risk factors for concurrent bacterial infection in HBV-ACLF patients were investigated by multivariate logistic regression analysis.The ROC curve analysis was performed to analyze the area under the ROC curve,in order to evaluate the diagnostic value of various risk factors for concurrent bacterial infection in HBV-ACLF patients.Results:1.A total of 219 patients with HBV-ACLF were collected,including concurrent bacterial infection group(hereinafter referred to as the infection group)(n=150)and non-concurrent bacterial infection group(hereinafter referred to as the non-infected group)(n=69).There were 107 patients with only one infection,accounting for 71.3% of the infected group;40 patients with 2 infections,accounting for 26.7% of the infected group;3 patients with 3 infections,accounting for the infected group 2.0%.According to the simple infection site,131 cases of spontaneous peritonitis occurred,44 cases of pulmonary infection,14 cases of cholecystitis,3 cases of bloodstream infection,3 cases of urinary tract infection,and 1 case of perianal abscess.The age,SIRS score,SIRS incidence,WBC,NEU%,PT-INR,PCT,TBIL,DBIL and ascites incidence in the infected group were greater than those in the non-infected group,the difference was statistically significant;The HGB,PTA,ALT,ALB and LDH in the infected group were lower than those in the non-infected group,the difference was statistically significant.The differences of SIRS score and ACLF staging distribution between the two groups were statistically significant.2.By performing multivariate logistic regression analysis on indicators with statistically significant differences between groups,the age,SIRS score,WBC,NEU,PCT and ascites were identified as risk factors for bacterial infection in patients with HBV-ACLF.[The OR value were 1.110,4.015,1.125,3.341,1.054,5.009 respectively,P<0.05.The 95%CI were(1.038-1.186),(1.646-9.794),(1.004-1.260),(1.582-7.439),(1.023-1.086),(2.283-10.992)respectively].3.By plotting the ROC curve of the risk factor,the AUC of age,SIRS score,WBC,NEU%,PT-INR,PTA,PCT,ALB,and ascites were identified to be 0.625,0.618,0.676,0.720,0.607,0.717,0.683,0.651,0.678 respectively.The AUC of SIRS score combined with age,SIRS score combined with NEU%,SIRS score combined with WBC,SIRS score combined with PTA,SIRS score combined with ALB,SIRS score combined with ascites,SIRS score combined with PCT,SIRS score combined with PT-INR,NEU% combined with PTA were identified to be 0.664,0.730,0.728,0.729,0.695,0.743,0.749,0.620,0.733 respectively.The positive predictive value of the seven joint indicators of appeals were 79.3%,80.9%,81.3%,81.1%,82.6%,84.0%,86.0%,81% and 80.0% respectively.The negative predictive values were 52.7%,54.7%,55.3%,56.9%,60.3%,50.0%,54.2%,53.0%,57.4% respectively.Conclusion:1.In patients with HBV-ACLF,SIRS score and PCT are risk factors for concurrent bacterial infection.The age,SIRS score,WBC,NEU%,PCT and ascites are risk factors for concurrent bacterial infection.The older the SIRS score,the higher the WBC value,the larger the NEU% value,the larger the PCT value,and the presence of ascites,the higher the risk of bacterial infection in HBV-ACLF patients.2.The AUC of the SIRS score combined with the PCT is the largest of all the individual indicators or the combined indicators,so it has the highest diagnostic value for concurrent bacterial infection in HBV-ACLF patients.