| Objective: Sepsis refers to a fatal organ dysfunction caused by the imbalance of response to infection.Due to its many pathogenic factors,complicated changes and rapid progress,there is still a lack of accurate and specific indicators in the early stage of the disease.Failure to judge the condition in time is also one of the reasons why sepsis has become a high mortality rate in critically ill patients.The study showed that gastric intramucosal pH(pHi)could reflect microcirculation perfusion and oxygenation in critically ill patients,and evaluate the severity and prognosis of the patients.There is no scientific basis to see the severity and prognosis of sepsis patients by measuring the changes of pHi.This study aims to analyze the correlation between pHi and severity and prognosis by measuring pHi in patients with sepsis,and evaluate the clinical value of pHi in evaluating the condition in patients with sepsis.Methods: A total of 78 patients(47 males and 31 females,between 35 and 85 years old,with a mean age of 65.7±12.56 years)admitted to the emergency department of the baoding NO.1 hospital from December 2016 to March 2018 were enrolled in the study.All selected patients met the Sepsis 3.0 diagnostic criteria that was issued by SCCM and ESICM in February 2016.The patients were divided into sepsis shock group and non-sepsis shock group according to the severity of illness on admission.The study endpoint was survival or death within 28 days after admission.The specificity between pHi and APACHEII score,SOFA score in evaluating the severity of illness and predicting prognosis was compared.The clinical value of pHi in the evaluation of sepsis patients was estimated.Gastric tube method was chosen for the determination of pHi.The statistical analysis was processed by SPSS22.0 software.Results:1.The pHi of survival group and death group was 7.36(7.33-7.40)and 7.21(7.20-7.25),respectively.There was a significant difference between the two groups.Compared with the survival group,the pHi of the dead group was significantly lower than that of the survival group,and the difference was statistically significant(z = 6.959,P<0.05).The APACHE II scores of survival group and death group were 12.0(8.0-18.0)and 14.0(14.0-21.0),respectively.There was no significant difference between the two groups and the difference was not statistically significant(z = 0.938,P> 0.05).The SOFA scores of survival group and death group were 4.0(2.0-6.0)and 6.0(4.0-9.0),respectively.There was no significant difference between the two groups and the difference was not statistically significant(z = 0.960,P > 0.05).2.Compared shock group with non-shock group,the difference in pHi,APACHE II score and SOFA score was statistically significant(P<0.05).The APACHE II score in the shock group was 21.0(19.8-24.3)higher than that in the non-shock group 12.0(8.3-15.0);the SOFA score in the shock group was 10.5(8.0-12.3)higher than that in the non-shock group 4.0(2.0-6.0);and the pHi value in the shock group was 7.34(7.27-7.36)significantly lower than that in the non-shock7.42(7.25-7.45).The data showed that APACHE II score and SOFA score were significantly increased in the shock group,while the pHi value was significantly decreased.All three can reflect the severity of sepsis.The pHi with APACHE II score and SOFA score were positively correlated,and the pHi was negatively correlated with the severity of the condition in patients with sepsis.The more critical the condition was,the lower the pHi value would be.Whereas,APACHE II score and SOFA score were on the contrary.3.ROC curve was drawn to evaluate the pHi value,APACHE II score,SOFA score and age in evaluating the clinical outcome(survive or death)in patients with sepsis at 28 days after admission.The area under the curve(AUC)of pHi was 0.93(95% CI: 0.87-0.97),and 0.676(95%CI: 0.69-0.85)for APACHE II score,0.696(95%CI: 0.74-0.84)for SOFA score,and 0.896(95%CI: 0.74-0.84)for age.The area under the curve(AUC)of pHi and age was more valuable than that of APACHE II score and SOFA score in predicting clinical outcome of sepsis at 28 days.The cutoff value of clinical outcome of sepsis predicted by PHI was 7.25,the sensitivity was 95.6%,and the specificity was 87.3%.The cutoff value of clinical outcome of sepsis at 28 days predicted by APACHE II score was 24,the sensitivity was 80.3%,and the specificity was 73.6%.The cutoff value of clinical outcome of sepsis at 28 days predicted by SOFA score was 12,the sensitivity was 81.1%,and the specificity was 72.5%.The sensitivity and specificity in predicting clinical outcome of sepsis at 28 days by pHi and age were higher than those by APACHE II score and SOFA score.The cutoff value of clinical outcome of sepsis at 28 days predicted by APACHE II score was 24,the sensitivity was 80.3%,and the specificity was 73.6%.The cutoff value of clinical outcome of sepsis at 28 days predicted by SOFA score was 12,the sensitivity was 81.1%,and the specificity was 72.5%.The cutoff value of clinical outcome of sepsis at 28 days predicted by age score was 63.5,the sensitivity was 91.3%,and the specificity was 76.9%.The sensitivity and specificity in predicting clinical outcome of sepsis at 28 days by pHi and age were higher than those by APACHE II score and SOFA score.Conclusion: The pHi value can reflect the microcirculation perfusion and oxygenation of the critically ill patients;helps understand the oxygenation in the whole body;and is able to judge the severity and prognosis of the disease earlier.The pHi value is negatively correlated with them.The lower the pHi value is,the more severe the disease will be.The pHi value is positively correlated with APACHE II score and SOFA score in evaluating the severity of sepsis.With respect to predicting the clinical outcome of sepsis at 28 days,pHi and age are more valuable than APACHE II score and SOFA score in predicting clinical outcome(survive or death)of sepsis at 28 days.The sensitivity and specificity are also significantly better than APACHE II score and SOFA score.Age is also a risk factor for prognosis in sepsis. |
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