The Value Of HMGB1,suPAR,WBC And PCT In Early Diagnosis And Prognosis Of Trauma Sepsis

Background With the development of society,especially the extensive application of modern means of transportation and the rapid development of infrastructure,the incidence of trauma is increasing year by year.The disability,death and a series of complications after trauma bring great threats to people's health and their families.Patients with severe trauma have three peaks of death:1.Occurred from seconds to minutes after the trauma occurred;2.Occurred from minutes to hours after the trauma occurred;3.Occurred from days to weeks after the trauma occurred.The third peak of death is in the field of critical illness research.The cause of death is mainly the late complications caused by trauma,especially traumatic sepsis,traumatic multifunctional organ failure and traumatic shock.For patients with trauma,it is particularly important to evaluate the condition correctly in the early stage,to understand the outcome of the disease and to take preventive treatment in advance to improve the survival rate and prognosis of patients.Although applications such as APACHE II and MODS scores are used to assess the prognosis of critically ill patients,they are limited by the limitations and complexity of each scoring system,and their prognostic value for trauma patients is also controversial.Researchers hope to provide predictive factors with high diagnostic value for the prognosis of trauma patients through laboratory tests and statistical analysis.Objective Early trauma continuous dynamic monitoring of high mobility group protein B1(HMGB1),soluble urokinase type plasminogen activator receptor(su PAR),white blood cell count(WBC),procalcitonin(PCT)in patients with severe multiple trauma,analyzing the value of each index and combined application in the evaluation of sepsis and sepsis prognosis in patients with severe multiple trauma.Method The clinical data of 114 patients with multiple injuries admitted to the second affiliated hospital of anhui medical university from October 2017 to March 2019 were retrospectively selected.All the patients had been hospitalized for no less than 7 days.Based on the presence or absence of Sepsis,the patients were divided into a Sepsis group of 71 and a non-sepsis group of 43.For the sepsis group,34 patients were divided into Shock group(34)and non-shock group(37)according to whether or not the patients had septic Shock.All patients were given blood samples on the 1st,3rd,and 5th day after admission.Patients with septic shock were given blood samples again on the same day.The HMGB1,su PAR,WBC,and PCT levels were measured,and the differences in each index were statistically analyzed and the predictive efficacy of traumatic sepsis and septic shock was evaluated.Results1.The HMGB1,su PAR,WBC and PCT levels of patients with severe multiple injuries were all higher in the Sepsis group than in the non-sepsis group 1,3 and 5 days after injury,with statistically significant differences(P<0.05).Dynamic detection of four indicators showed that the increase of HMGB1 was slower than that of the other three indicators in the non-sepsis group.For the prediction of septic shock,all the four had certain value,and the difference was statistically significant(P<0.05).2.Detecting HMGB1,su PAR,WBC,and PCT alone has certain value for the early diagnosis of sepsis in patients with severe multiple trauma.The cut-off points on the first day after injury are 8.43 ng/ml,6.07 ng/l,and 17.53×109/L,respectively.,4.07 ng/ml,the values of the indicators in the Seppsis group were(10.72±4.32)ng/ml,(7.07±2.95)ng/l,(16.30±5.52)X10~9/L,(6.61±2.17)ng/ml,non-Sepsis The values of the indicators in the group were(7.02±3.06)ng/ml,(3.46±1.66)ng/l,(14.11±4.29)X10~9/L,(3.33±1.23)ng/ml,and the single index was the highest diagnostic power of PCT.0.902,sensitivity 84.51%,specificity 88.37%,the combined prediction of su PAR,WBC and PCT has higher AUC 0.970,sensitivity88.37%and specificity 95.35%.3.For the prediction of septic shock,the cutoff points of HMGB1,su PAR,WBC,and PCT were 40.79 ng/ml,12.43 ng/l,16.65X10~9/L,and 9.14 ng/ml,respectively.The values of the indicators on the day of sepsis were(47.66±11.52)ng/ml,(15.02±3.22)ng/l,(19.11±4.69)X10~9/L,(11.02±2.90)ng/ml.The highest AUC 0.848,sensitivity 79.41%and specificity 75.68%of the single index were predicted by su PAR,the combined prediction of HMGB1,su PAR and PCT has higher AUC 0.930,sensitivity 94.12%and specificity 83.78%.Conclusion HMGB1,su PAR,WBC and PCT have certain evaluation value for the diagnosis of early sepsis and the prognosis of patients with severe multiple injuries,and the combined prediction value is higher.