| Objective:To explore clinical significance of the level of coagulation index and inflammatory factor of sepsis patients with positive bacterial culture.Methods:Retrospective analysis was used to select the clinical data of 117 cases of bacteria-culture-positive sepsis patients admitted to the emergency department and ICU of the second affiliated hospital of An Hui medical university on January 1,2015 and October 1,2018.Exclude those who do not have a clear prognosis.They were divided into the death group and the survival group according to the 28-day prognosis.Collected and recorded the patients' general data,bacteriological results,and the worst values of between coagulation and inflammatory indicators on the first day of admission.According to the bacterial culture results,it was divided into gram positive bacteria group and gram-negative bacteria group,blood culture positive group and sputum culture positive group.The differences between the three groups were compared.we selected the relevant indicators to affect the prognosis of sepsis patients through single factor analysis,and selected independent risk factors to affect the prognosis of sepsis patients through multivariate Logistic regression models.Predictive efficacy of continuous-type variables for the prognosis of sepsis patients and the appeal index in the value of bacterial species judgment were completed using the receiver operating characteristic curve(ROC).The results were quantitatively described using the area under the curve.Results:1.There was no significant difference in WBC between the death and survival groups(9.7 [4.06,18.28])vs(12.30 [8.8,17.64],P > 0.05);there was no significant difference between the Gram-negative and Gram-positive groups(11.18 [5.74,15.92]vs 11.47 [5.51,2.76],P > 0.05);Blood culture positive group and sputum culture positive group had no significant difference(11.8 [5.57,23.06] vs 11.24 [5.73,15.78],P > 0.05).2.PCT: The death group was significantly higher than the survival group(40.98 [17.31,53.27])vs 20.97 [13.18,43.37],P < 0.05);the Gram-negative group was significantly higher than the Gram-positive group(34.40 [17.84,50.38] vs 20.42[8.79,42.11],P < 0.05);blood culture positive group and sputum culture positive group(38.67 [19.28,50.93] vs 21.71 [10.22,43.01],P < 0.05).3.IL6: The death group was significantly higher than the survival group(2062.22 [1295,3480.5] vs1505 [773.25,2062.22],P < 0.05);the Gram-negative group was significantly higher than the Gram-positive group(1870 [1175.5,2512.25] vs 1,255 [896.5,2103.61],P <0.05);blood culture positive group and sputum culture positive group(1941 [1249,2449.5] vs 1527 [717,2062.2],P < 0.05).4.PT: The death group was significantly higher than the survival group(16 [14,19.45] vs 14.1 [13.3,15.47];P < 0.05);there was no significant difference between the Gram-negative group and the Gram-positive group(14.6 [13.53,16.55] vs 15.7 [13.4,18.65];P > 0.05);blood culture group and phlegm culture group had no significant difference(15.4 [13.85,18.2] vs 14.3 [12.72,16.75];P > 0.05).5.INR: The death group was significantly higher than the survival group(1.35 [1.24,1.65] vs 1.22 [1.12,1.36];P < 0.05);the Gram-negative group was significantly lower than the Gram-positive group(1.28[1.12,1.41] vs 1.34 [1.24,1.68]);P <0.05);blood culture group and phlegm culture group had no significant difference(1.32 [1.2,1.5] vs 1.26 [1.12,1.52];P > 0.05).6.APTT: Death versus Survival Group(52.1 [40.75,64.2] vs 41.15 [36.05,46.7],P <0.05);Gram-negative versus Gram-positive Group(41.75 [34.83,54.17] vs 49.4[43.55,59.75]);P < 0.05);blood culture group and phlegm culture group had no significant difference(44.9 [36.9,61.05] vs 44.4 [37.12,52.27];P > 0.05).7.DD:death and survival groups(6.82 [4.71,8.01] vs 3.65 [1.49,6.75];P < 0.05);Gram-negative and Gram-positive groups(5.08 [2.68,7.73] vs 5.98 [3.89,7.77];P >0.05);blood culture group and phlegm culture group(6.82 [3.85,7.89] vs 4.71 [2.39,7.29];P < 0.05).8.TT: There was no significant difference between the death group and the survival group(18.1 [16.9,19.8] vs.17.45 [16.65,19.3];P > 0.05),and there was no statistical difference between the Gram-negative group and the Gram-positive group(17.65 [16.8,19] vs.18.1 [17,20.2];P > 0.05);blood culture group and phlegm culture group had no significant difference(17.8 [17.2,19.15] vs 17.75 [16.5,20.1];P > 0.05).9.PLT: death group and survival group(94 [34,124.5] vs 133.5 [84.5,184.5];P < 0.05);There was no significant difference between gram-negative group and gram-positive group(114.5 [55.2,165.5] vs 107 [58.5,133.5];P > 0.05);blood culture group and phlegm culture group(90.0 [45.0,130.0] vs 130.5 [86.0,159.5];P <0.05).10.Univariate analysis with statistical significance was incorporated into the Logistic regression model to analyze the prognostic risk factors of patients with sepsis.The results showed that d-dimer,Il-6 and PLT levels were independent risk factors for the prognosis of patients with sepsis.ROC curve analysis showed that the AUC of DD and Il-6 in predicting poor prognosis were 0.728(95%CI0.646-0.820)and 0.644(95%CI0.544-0.744),respectively.The AUC of PLT predicted good prognosis was0.717(95%CI0.625-0.809).11.According to the ROC,in predicting the value of bacterial species,the AUC of gram-negative bacteria predicted by PCT,Il-6 was > 0.5,0.638(95%CI0.530-0.746),0.621(95%CI0.516-0.727)and 0.567(95%CI0.463-0.671),respectively.Thus,PCT and IL-6 are effective in predicting gram-negative bacteria.In the prediction of gram-positive bacteria,The AUC of INR and APTT were 0.577(95%CI0.460-0.693),0.651(95%CI0.552-0.750),respectively.It can be seen that the level of APTT is more effective in predicting the efficacy of gram-positive bacteria.Conclusion:The levels of PCT,IL-6 and APTT were related to the species of bacteria.The increased levels of PCT and IL6 indicated the possibility of Gram-negative bacterialinfection,and prolongation of the APTT level in the coagulation index can predict the gram-positive bacterial infection.Therefore,the above index can be used to help clinicians judge the type of bacteria in patients with sepsis and to help the choice of antibiotic treatment before showing the results of bacterial culture.In terms of prognosis,DD,Il-6 and PLT levels are independent risk factors affecting the prognosis of patients with sepsis and can be used as prognostic indicators. |
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