Clinical Study Of Nonviral Infection-Related Lymphocytopenia For The Prediction Of Adult Sepsis And Its Associated Mortality

BackgroundSepsis is a life-threatening disease that affects 30 million people worldwide each year.Despite the rapid advances in medical technology and organ support systems,it is still difficult to reduce the mortality rate.Studies have confirmed that the time of death caused by sepsis presents a"double-peak"distribution,that is,early death within a few days and late death within a few weeks or months.Early death is mainly caused by continuous shock or organ failure caused by"inflammatory storm",while late death is mainly characterized by immunosuppression,which makes the primary infection difficult to control or increases the"secondary"opportunistic infection and eventually leads to organ failure and death.In recent years a large number of large-scale clinical trials about anti-inflammatory medication all failed,so early anti-inflammatory therapy does not benefit in survival,but the period of the complexity of the mechanism of immune dysfunction also determines its difficult to improve in a short time to get treatment effect.Early identification of sepsis may be an important way to solve this problem,which will have great and far-reaching significance for improving the treatment and prevention of sepsis.Sepsis guidelines have been updated for three times.Sepsis-1.0 is simple and easy to operate,with high sensitivity but low specificity,and the probability of false positive diagnosis is significantly increased.Sepsis-2.0contains a total of 19 indicators,including general parameters,inflammatory parameters,hemodynamic parameters,organ function indicators and tissue perfusion parameters,and it was so complex that it could not be widely used in clinics.The definition of sepsis-3.0 focuses on the connotation of organ function damage caused by Sepsis,namely SOFA score.The specificity increases,but the early recognition and the sensitivity decrease.Moreover,In addition,it is difficult to rapidly obtain and widely carry out the various organ function indicators in the emergency clinic.Although qSOFA is used as a supplement,its specificity is low.Therefore,the sepsis-3.0 standard is difficult to meet the clinical requirements of early and rapid recognition of Sepsis,especially in the outpatient and emergency departments.Therefore,it is urgent to explore a highly sensitive and specific evaluation method to guide clinical practice and improve the outcome of sepsis.Pathophysiological characteristics determines that the sepsis of indicators to be looked for should not only give consideration to the evaluation of infection,but also provide early indication of organ function damage,which can meet the requirements of simple and easy to obtain,easy to read,reasonable price and easy to promote,etc.Therefore,the blood routine lymphocyte count test is expected to meet the above requirements,to a certain extent,which can help clinicians,especially the outpatient and emergency physicians,to have an early warning effect on the early identification of sepsis,blocking the explosive inflammatory reaction of sepsis,and improving the prognosis of sepsis.This study was designed to investigate the role of absolute Lymphocyte Coun(Lym)and other relevant clinical indicators such as white blood cell(WBC),neutrophil count(N#),procalcitonin(PCT),arterial lacacid(Lac)in the rapid diagnosis and prognosis evaluation of adult non-viral infective sepsis.In this study,a total of 100 adult patients with non-viral infection were analyzed in terms of lymphocyte count and the diagnostic efficacy of lymphocyte count reduction in sepsis,and the prognostic assessment of patients with sepsis by continuous lymphocyte count reduction was further analyzed,providing theoretical basis for early identification of sepsis and its prognostic assessment.MethodsThis study retrospectively analyzed the adult patients with non-viral infection in the first affiliated hospital of chongqing medical university from September 2016 to September 2018,including a total of 77 patients with sepsis and 23 patients with non-sepsis.Patients'daily Lym,WBC,N#,PCT,Lac were recorded,and APACHE II score and SOFA score were evaluated until discharge or death.Univariate and multivariate Logistic regression models were used to analyze the correlation between Lym,WBC,N#,PCT,Lac and APACHE II scores and adult non-viral sepsis.The AUC under ROC was used to compare the diagnostic performance of Lym,WBC,N#,PCT and other biomarkers in early adult non-viral sepsis.Results1.In early non-viral infection,Lym level in the sepsis group was significantly lower than that in the non-sepsis group.2.Univariate analysis of early identification of adult non-viral sepsis showed that WBC,N#,Lym,PCT,Lac and APACHE II scores were significantly different(P<0.05);Multivariate analysis showed that WBC,N#,Lym and PCT were significant in the early identification of adult non-viral sepsis(P<0.05).3.The diagnostic efficacy of Lym was significantly better than that of WBC,N#and PCT(P<0.001).Lym has a high value in the early diagnosis of adult non-viral sepsis,with an AUC of 0.971(95%CI=0.942-1.000)and a cut-off value of 0.76*10~9/L(with a sensitivity of 89.01%,specificity of85.57%,positive predictive value of 95.1%and negative predictive value of 69.7%.)4.In adult patients with non-viral sepsis,Lym duration(3 days)was less than 0.76*10~9/L,and the 28-day mortality was 39.66%,significantly higher than that in the non-lym continuous reduction group.Conclusion1.Lym significantly decreased in early adult patients with non-viral sepsis.2.The diagnosis of sepsis requires high vigilance when non-viral infection is suspected and lymphocytopenia is below the optimal cut-off value(0.76*10~9/L).In addition,Lym is significantly better than WBC,N#and PCT in the early diagnosis of adult non-viral sepsis.3.Persistent lymphocytopenia(less than 0.76*10~9/L)for more than 3days indicates a significant increase in 28-day mortality,which can be used as a prognostic indicator of adult non-viral sepsis.