| [Objective] To investigate the significance of fecal calprotectin,D-lactic acid,and bedside gastrointestinal ultrasound image data for early warning and prognosis of sepsis with acute gastrointestinal injury(AGI),and the effect of blood purification on fecal calprotectin and D-lactic acid.[Methods]Patients with sepsis who were admitted to EICU of The First Hospital of Dalian Medical University from January 2019 to December 2019 and met the diagnostic criteria of “Sepsis 3.0”(n = 54)were collected and divided based on whether they underwent acute gastrointestinal injury into group A(n = 29),sepsis with AGI,and group B(n = 25),sepsis without AGI.Furthermore the both were separately grouped into group A1 of sepsis with AGI treated with blood purification(n = 13),group A2,sepsis combined with AGI without blood purification,(n = 16),and group B1,sepsis treated with blood purification without AGI,(n = 11),group B2,sepsis without AGI and the treatment of blood purification(n = 14).Gastrointestinal ultrasound images and data,fecal and venous blood of the patients were collected on day 1,3 and 7 of admission.Monitor the 28-day deaths.Healthy volunteers of the same period were selected as group C(n = 15),and ultrasound images and date,fecal,venous blood and were also collected.Analyze the prognosis of disease by calculating the results of COX stepwise regression analysis.U-test,area under the ROC curve(AUC)were used to compare the differences in fecal calprotectin,blood D-lactic acid,and gastrointestinal ultrasound image datas in the early diagnosis of sepsis with acute gastrointestinal injury,and the evaluation of prognosis,and investigate the effect of blood purification treatment on indicators,as mentioned above.[Results](1)Whether or not sepsis was associated with acute gastrointestinal injury,fecal calprotectin,D-lactic acid,cross-sectional area of gastric antrum,small bowel and colon wall thickness were larger than that of the healthy group(P <0.05);The ratio of internal-external meridians,cross-sectional area of the small bowel and colon were smaller than those in the healthy group(P <0.05);(2)The fecal calprotectin,D-lactic acid,cross-sectional area of the gastric antrum,and the thickness of the small intestine wall of sepsis with AGI were larger than those in the group of sepsis without AGI(P<0.05).The ratio of internal-external meridians,cross-sectional area of the small bowel were smaller than those in the group of sepsis without AGI(P <0.05).(3)There's no difference in the thickness of colon wall,the ratio of internal-external meridian,and cross-sectional area between sepsis with AGI and those without AGI.(P> 0.05);(4)The difference of fecal calprotectin and D-lactic acid on the first and third days of sepsis with AGI treated with blood purification was higher than those of sepsis combined with AGI without blood purification(P <0.05);Regardless of whether the patients with sepsis without AGI were treated with blood purification or not,there's no difference in the difference of fecal calprotectin on day 1 and day 3(P> 0.05).The difference of D-lactic acid on the first and third day of sepsis treated with blood purification without AGI was higher than those of sepsis without AGI and the treatment of blood purification(P <0.05).(5)When fecal calprotectin was higher than 115.25 ug/g and D-lactic acid was higher than 22.16 umol / L,they had the diagnostic value for sepsis complicated with acute gastrointestinal injury.The area under the curve of D-lactic acid is bigger than the fecal calprotectin's.(6)D-lactic acid is an independent risk factor for sepsis with acute gastrointestinal injury.(7)Fecal calprotectin and D-lactic acid have no significance in the evaluation of the prognosis of sepsis combined with acute gastrointestinal injury.[Conclusion] 1.Fecal calprotectin and D-lactic acid have early diagnosis effect on sepsis with acute gastrointestinal injury.D-lactic acid is superior to fecal calprotectin in the diagnosis of sepsis with acute gastrointestinal injury,and is an independent risk factor for this disease.2.Bedside ultrasound of gastric antrum cross-sectional area,small intestinal wall thickness have the early warning effect on acute gastrointestinal injury with sepsis.3.Blood purification therapy can significantly reduce fecal calprotectin and D-lactic acid levels in patients with sepsis combined with acute gastrointestinal injury. |
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