Clinical Characteristics And Prognostic Risk Factors In Elderly Sepsis Patients With ICU

Objective:To explore the clinical characteristics and prognostic risk factors of senile sepsis patients in internal medicine ICU,and to provide evidence for clinical diagnosis and treatment of senile sepsis.Methods:From October 2017 to October 2018,49 elderly patients with sepsis who were clearly diagnosed and hospitalized in the Department of critical Medicine of Chengde Central Hospital were collected.According to the outcome of treatment,the patients were divided into survival group(26 cases)and dead group(23 cases).Sex,age,infection site,aetiological collection,length of stay of BMI,were recorded and procalcitonin(Procalcitonin,was measured within 24 hours after admission.Serum creatinine,(Serum creatinine,SCr),cystatin,C(Cystatin c,Cys c),albumin,(albumin,ALB),lactic acid(Lactic acid,Lac)in PCT),were calculated according to the maximum value of indexes within 24 hours after admission,and the sequential organ failure score(Sequential organ failure assessment,SOFA),)was calculated.Acute physiological and chronic health score(acute physiologital and chronic health evalution ?,APACHE ?),Glasgow coma score(Glasgow coma scale,GCS),and whether blood purification,mechanical ventilation,vasoactive drugs were used.Treatment outcome(28-day fatality rate).and Statistical analysis of the indexes of the above two groups of patients.Results: 1.Comparison of general data and clinical indicators 1.1 Analysis of general data of two groups of patientsThere were 24 males(49%)and 25females(51%)in 49 elderly patients with sepsis.The age of death group was significantly higher than that of survival group.The most common infection sites were lung(44.9%),urinary system(22.4%),abdominal cavity(20.4%)and skin(12.2%).The most common pathogens were Escherichia coli(49%),Klebsiella pneumoniae(26.5%),Streptococcus pneumoniae(8.2%),Candida albicans(6.1%).There were 2 cases of Pseudomonas aeruginosa(4.1%),1 case of Staphylococcus aureus(2%),1 case of Staphylococcus epidermidis(2%)and 1 case of Acinetobacter baumannii(2%).1.2 Single factor analysis of clinical indexes in two groupsThere was no significant difference between the survival group and the dead group in terms of sex,length of hospitalization,serum creatinine of BMI,and whether to use mechanical ventilation(P > 0.05).There were statistical differences between the two groups in age,PCT,Cys c,ALB,Lac and APACHE?score,SOFA score,blood purification treatment and use of vasoactive drugs(P < 0 05).2.Multivariate Logistic regression analysisCys c(OR=0.924,P=0.841),PCT(OR=1.096,P=0.240),GCS score(OR=0.958,P=0.850)was not an independent risk factor for predicting death.Age(OR=0.934,P=0.049),vasoactive drugs(OR=0.014,P=0.002),continuous blood purification therapy(OR=0.074,P=0.04),SOFA score(OR= 0.704,P < 0.027),APACHE ? score(OR=0.802,P < 0.01).P = 0.048),Lac(OR=0.629,P = 0.013),ALB(OR=1.376,P=0.007)were independent prognostic risk factors.3.Receiver operating characteristic curve(ROC curve)Further drawing the receiver operating characteristic curve(ROC curve),To determine the area under the curve of sepsis patients by ROC curve?Optimal cut-off value,Sensitivity and specificity of risk factors for predicting prognosis of sepsis at optimal cut-off value?The AUC of age?Lac?AlB?APACHE? score?SOFA score,for predicting the risk of death was:0.817(95%CI 0.70~0.935)?0.845(95%CI 0.734~0.956)?0.162(95%CI 0.05~0.273)?0.697(95%CI 0.547~0.847)?0.874(95%CI 0.778~0.97)?The results were as follows: the age cut off value was 65.5 years old(the sensitivity was 95.9%,the specificity was 44.4%),Lac was 1.05 mmol/L(the sensitivity was100%,the specificity was 88.9%),ALB was 14g/L(the sensitivity was 95.5%,the specificity was 100%),The SOFA score was 7(the sensitivity was 100%,the specificity was 51.9%)and APACHE ? score was 14(the sensitivity was 100%,the specificity was 92.5%)? 4.Spearman correlation Analysis : Cys c and SCr,Lac and SOFA scoresThere was a positive correlation between the increase of Cys c and SCr level,P=0.001(P <0.05),r=0.471;There was a positive correlation between the increase of Lac and SOFA score,P=0.02(P <0.05),r=0.332?Conclusion:The most common site of infection in elderly patients with sepsis is the lungs,and the most susceptible pathogen is Escherichia coli.Age,ALB,SOFA score,ALB,APACHE ? score,application of vasoactive drugs and blood purification therapy are independent risk factors for predicting death in elderly sepsis patients.Compared with other indexes,SOFA score is better in predicting prognosis of elderly sepsis patients.