Analysis Of Sepsis Mortality Factors In ICU And Based On Bioinformatics To Analysis Of Related Pathogenic Genes

OBJECTIVE:By analyzing the results of laboratory tests and prognosis of patients with sepsis,the related factors affecting the prognosis of patients with sepsis were discussed in order to provide evidence for effective treatment of sepsis and reduction of hospital mortality.Methods:Using the method of retrospective investigation and analysis,870 sepsis patients treated in ICU ward from June 2016 to June 2018 in our hospital were selected as clinical research objects.According to the prognosis of the patients,all sepsis patients were divided into survival group and death group.Age,sex,vital signs at admission,infection site and basic diseases were recorded.Blood routine,electrolyte,arterial blood gas,liver function and renal function were collected within 24 hours of admission,and pathogenic microorganisms were cultured according to the infection site.Lac value was measured 24 hours after admission and lactate clearance rate was calculated 24 hours after admission.Acute physiology and chronic health score II(APACHE II)and SOFA score were calculated by the worst value within 24 hours after admission.A series of biochemical indexes including oxygenation index,blood lactic acid(Lac),24-hour lactate clearance rate,serum procalcitonin(PCT),C-reactive protein(CRP),total bilirubin(TBiL),platelet count(PLT)were examined and measured.The parameters include coagulation time(PT),albumin(ALB),urea nitrogen(BUN),white blood cell count(WBC),aspartate aminotransferase(AST),alanine aminotransferase(ALT),creatinine(Cr)and creatine kinase isoenzyme(CK-MB).Results:We found it had no significant difference between the death group and the survival group in sex,average age and age < 60 years old(P > 0.05),but the proportion of the death group aged(> 60 years old)was higher than that of the survival group(P < 0.05).The proportion of Gram-negative bacterial infections,fungal infections,ARDS/AKI/DIC and the number of failed organs in the former was higher than the latter group,while the Gram-positive group was higher than that in the survival group.The proportion of bacterial infection was lower than that of survival group(P < 0.05),and there was no difference in infection site,myocardial injury,septic encephalopathy,acute liver injury and stress ulcer(P > 0.05);the proportion of patients with cardiac insufficiency in death group was higher than that in survival group(P < 0.05),while the proportion of patients with diabetes,COPD and hypertension in two groups was higher than that in survival group(P < 0.05).There was no difference in the proportion of the number(P > 0.05);the proportion of the survival group receiving anticoagulation treatment and continuous blood purification was higher than that of the death group(P < 0.05);the time of TPN treatment and mechanical ventilation was no difference between the two groups(P > 0.05);there was no difference in hospitalization time between the survival group and the death group(P > 0.05).0.05).Compared with the death group,there were no significant differences in WBC,TBiL,PLT,oxygenation index,ALT,CK-MB,Cr,BUN,AST,ALB,PT and PH between the survival group and the deathgroup(P > 0.05).There were significant differences in Lac,24-hour lactate clearance rate,CRP,PCT,APACHE II score and SOFA score between the two groups(P < 0.05).Lac,APACH and SOFA score in the death group were significantly different(P < 0.05).The E II score and SOFA score were higher than those of survival group,while the lactate clearance rate at 24 hours was lower than that of survival group.Univariate analysis of factors that may affect the prognosis of patients during hospitalization showed that age,PCT,Lac,SOFA score,APACHE II score,24-hour lactate clearance rate,fungal infection,Gram-negative bacterial infection,complications,receiving anticoagulation treatment,and continuous blood purification were the prognostic factors(P <0.05).Multivariate COX regression analysis was used to analyze the prognosis of sepsis patients.The results showed that APACHE II score,24-hour lactate clearance rate,ARDS and DIC were independent risk factors for the prognosis of sepsis patients.Conclusion:(1)The prognosis of sepsis patients in ICU is influenced by many factors,such as basic diseases,infectious microorganisms,complications and interventional therapy.(2)APACHE II score,24-hour lactate clearance rate,ARDS and DIC were independent risk factors affecting the prognosis of ICU patients.(3)The differentially expressed genes showed that the expressions of the six key genes,KLHL3?ADAM28?NKTR?TPST1?MCRIP2?CCND3?DMMA2?...