Clinical Value Of Detection Of D-lactic Acid And Intestinal Fatty Acid Binding Protein In Early Diagnosis Of Acute Gastrointestinal Injury In Sepsis

Objective: to study the clinical value of D lactic acid and intestinal fatty acid binding protein in early diagnosis of acute gastrointestinal injury in sepsisMethods:In a prospective study,44 children(aged from 2 to 14 years old,who met the diagnostic criteria of sepsis published in the August 2015 edition of Chinese Journal of Pediatrics)who were diagnosed as sepsis and had symptoms of gastrointestinal injury in Pediatric intensive Care Unit(Pediatric intensive care unit,PICU)of Hebei Medical University from January to December in 2019 were divided into sepsis group and septic shock group according to the presence of tissue hypoperfusion and cardiovascular dysfunction.Acute and chronic gastrointestinal diseases were excluded.According to the definition and grading standard of acute gastrointestinal injury(Acute gastrointestinal injury,AGI)put forward by the European Association of critical Care Medicine in 2012,the experimental group was divided into AGI I group,AGI II group,AGI III group and AGI IV group.Healthy children in the child care clinic of our hospital at the same stage were selected as the control group(healthy control group).Venous blood samples were collected from children with sepsis on the day of admission,and venous blood samples were collected from the health control group at the child care clinic.The serum levels of intestinal fatty acid binding protein(Intestinal fatty acid binding protein,IFABP),D-lactic acid,C-reactive protein(Creactive protein,CRP)and procalcitonin(Procalcitonin,PCT)were measured,and the sex,age and underlying diseases of all children were recorded.The receiver operating characteristic curve(Receiver operating characteristic,ROC)was drawn to evaluate the value of D-lactic acid and IFABP in the diagnosis of AGI in children with sepsis.Results: 1.There was no statistically significant in sex,age and underlying diseases among the subjects in each group(P>0.05).2.Analysis of serum indexes: the levels of serum IFABP,D-lactate,Analysis of serum indexes: the levels of serum IFABP and D-lactate in the experimental group(sepsis group and septic shock group)were significantly higher than those in the healthy control group(all P<0.05),and the levels of IFABP and D-lactate in the septic shock group were significantly higher than those in the sepsis group(P<0.05).The levels of IFABP and D-lactate in AGI groups were higher than those in the control group(all P<0.05),and their indexes gradually increased with the increase of AGI grade,and the difference was statistically significant(all P<0.05).3.Correlation analysis: on the day of admission,serum IFABP and D-lactic acid were positively correlated with CRP,PCT and AGI grades in children with sepsis(all P<0.05).4.Diagnostic value analysis:(1)The area under the ROC curve of AGI diagnosed by D-lactic acid is high,(AUC)is 0.909,the prediction accuracy is high,and the 95% confidence interval(95%CI)is 0.840 ?g/m L.When the best cutoff value is 50.610?g/m L,the sensitivity and specificity are 90% and 79.5%,respectively.(2)The area under the ROC curve of AGI diagnosed by IFABP is very high,(AUC)is 0.944,the prediction accuracy is high,and the 95% confidence interval(95%CI)is 0.890 to 0.999.When the best cutoff value is 223.855pg/m L,the sensitivity and specificity are 100% and 86.4%,respectively.Conclusion:1.Serum IFABP and D-lactic acid increased in the early stage of sepsis complicated with acute gastrointestinal function injury,which can be used as a sensitive and specific serological index for early diagnosis.2.The levels of serum IFABP and D-lactic acid in children with sepsis were positively correlated with the grades of CRP,PCT and AGI.The more serious the inflammation and the more serious the condition,the more serious the gastrointestinal injury.