Prognostic Assessment Of Wasp Stings-induced MODS With Serum Lactate Combined With Critical Illness Scores

Objective:Wasp stings is a common toxic disease in Sichuan area.It causes harm to the human body through the toxic effect of melittin on organs,as well asallergic reaction and inflammation induced by melittin,which can lead to multiple organ dysfunction syndrome(Multiple organs dysfunction syndrome,MODS)or even death.The aim of this study was to investigate the risk factors of death and prognosis in patients with MODS caused by wasp stings by comparing the levels of serum lactate and three critical illness scores,and combining the levels of serum lactate with three critical illness scores,to provide basic for clinician to judge the prognosis of patients.Methods:The basic information,laboratory data,sequential organ failure assessment(SOFA)score,poisoning severity score(PSS),acute physiology and chronic health status score ?(APACHE?)within 24 hours after admission,as well as treatment and outcome of patients with wasp stings inducesd MODS from January 2015 to December 2019 in affiliated hospital of Sichuan North Medical College were collected.SPSS22.0 statistical software was used to analyze the data,and univariate Logistic regression was used to analyze the risk factors of death,then the selected risk factors were analyzed by multiple Logistic regression to analyze the independent risk factors of death.Patients were divided into survival group and death group at the 28-day time node.The ROC curves of SOFA score,PSS score,APACHE? score and serum lactate,and the ROC curves of serumlactate combined each of the three score were drawn and the AUC area under the curves was compared.Results:A total of 56 patients with wasp sting-induced MODS in the Affiliated hospital of North Sichuan Medical College from January 2015 to December 2019 were enrolled in the study,with a mortality rate of 28.57%.There were 40 people in the survival group and 16 in the death group.(1)There was no significant difference between the two groups in sex,the season of wasp stings,acute allergic reaction,time elapse from bite to hospital,WBC,HGB,TBIL,CR,BUN,CK-MB(P>0.05).Whereas there were notable differences in sting number,blood purification,age,PT,APTT,the level of AST,ALT,ALB,LAC,TNT-HS in plasma(P<0.05);(2)The number of stings,blood purification,age,AST,ALT,ALB,LAC,PT,APTT,TNT-HS were analyzed by binary Logistic single factor analysis,the results showed that age,LAC,PT,APTT,TNT-HS,number of stings,blood purificationwere significantly different(P<0.05)and OR>1,ALB was significantly different(P<0.05)and OR<1;(3)The age,LAC,PT,APTT,TNT-HS,number of stings,blood purification were included in the binary Logistic multivariate analysis.The results showed that there were significant differences in LAC(P<0.05);(4)The three scores in the death group were obvious higher than the survival group,the AUC from high to low were APACHE? 0.880(95%CI 0.781-0.978),SOFA 0.819(95%CI 0.701-0.937),PSS 0.697(95%CI 0.501-0.893).(5)The AUC of three different scores combined with serum lactate all increased and the difference was statistically significant(P<0.05),from high to low were LAC+APACHE? 0.923(95%CI 0.820?0.977),LAC+SOFA0.895(95%CI0.784?0.961),LAC+PSS 0.820(95%CI0.695?0.910).Conclusions:1.Age,PT,APTT,TNT-HS,number of stings,blood purification treatment were the risk factors for the prognosis in wasp sting-induced MODS,serum lactate level was the independent risk factor,and plasma ALB were the protective factor for prognosis in MODS caused by wasp stings.2.The scores of APACHE?,SOFA and PSS were significant in predicting the death of wasp stings-induced MODS,and the APACHE? has the highest sensitivity.3.The clinical value of APACHE?,SOFA and PSS combined with serum lactate in predicting death was better than that of APACHE?,SOFA,PSS and lactate alone,and APACHE?+LAC was the best.When APACHE??20,LAC?5,the sensitivity and specificity of predicting the mortality of the patients with wasp stings induced MODS were 81.25%and 100%.