The Efficiency Of The International Standardized Ratio (INR) For The Early And Fast Identification Of Adult Nonpulmonary Infectious Sepsis

Background:The disease burden caused by sepsis is increasing annually,which seriously endangers the life and health of patients.The study confirmed that the time of death in sepsis patients was divided into early death and late death,with early death caused by an aggressive inflammatory response occurring within a few days,and late death caused by continued immunosuppression within a few weeks or months.At present,a number of clinical studies of early anti-inflammatory therapy have failed,and the mechanism of late immunosuppression not being clear,which lead to the therapeutic effect and mortality of sepsis has not been improved.Therefore,early recognition might be an important way to improve the treatment of sepsis in the short term.Because Sepsis-3.0,the latest diagnostic criteria,involves many and complex detection indicators,and qSOFA is less sensitive to sepsis screening,it is necessary to find new indicators for the early and rapid identification of sepsis.The study found that patients withabdominal and urinary tract infection were more likely to deteriorate into severe sepsis or septic shock rapidly than pulmonary infection,and the complications and clinical consequences caused by delayed diagnosis were more serious.Sepsis caused by pulmonary infection has prominent clinical symptoms,which are easy to be recognized early and low dependence on screening tools.However,the symptoms of nonpulmonary infectious sepsis patients are more insidious and likely to develop shock,which should be recognized as soon as possible.Therefore,it is more important for the early and fast screening of patients with nonpulmonary infectious sepsis.In addition,sepsis patients are associated with different degrees of coagulation dysfunction throughout the whole process.So coagulation indicators can provide an important reference for the early identification of adult nonpulmonary infectious sepsis.Hence,the purpose of this study was to explore the efficiency of the conventional coagulation indicators such as the international standardized ratio(INR),prothrombin time(PT),activated partial thromboplastin time(APTT)and blood routine indicators such as white blood cell(WBC),neutrophil–lymphocyte count ratio(NLCR),platelets(PLT),and qSOFA for the early rapid recognition of adult nonpulmonary infectious sepsis.Methods:This study was a retrospective cohort study conducted to include 128 adult patients with clinically suspected or confirmed infection hospitalizedin the Department of the Intensive Care Unit of the First Affiliated Hospital of Chongqing Medical University.According to the Sepsis 3.0 standard,the patients divided into a total of 70 sepsis patients and 58 nonsepsis patients.WBC,N#,L#,NLCR,PLT,the INR,PT and APTT were recorded within24 hours after admission.SOFA,APACHE II and qSOFA were assessed.Univariate and multivariate Logistic regression models were used to analyze the correlation between INR?WBC?NLCR?PLT?PT?APTT?qSOFA and adult nonpulmonary infectious sepsis.Then the AUC under ROC was used to compare the diagnostic performance of the above indicators in early adult nonpulmonary infectious sepsis.Results:1.INR level in the early adult nonpulmonary infectious sepsis group was significantly more increased than that in the nonsepsis group.2.Univariate analysis of early identification of adult nonpulmonary sepsis showed that WBC?NLCR?INR?PLT?PT?APTT and qSOFA were significantly different(P < 0.05);Multivariate analysis showed that WBC?NLCR?INR?PLT and PT were significant in the early identification of adult nonpulmonary sepsis(P < 0.05).3.The diagnostic efficacy of INR was significantly better than that of WBC?NLCR?PLT?PT and qSOFA(P < 0.05).INR has a high value in the early diagnosis of adult nonpulmonary sepsis,with an AUC of 0.918(95%CI=0.857-0.959)and a cut-off value of 1.22(with a sensitivity of90.0%(95% CI=80.5%-95.9%),specificity of 84.48%(95% CI=(72.6%-92.7%),positive predictive value of 87.5%(95% CI=79.3%-92.8%)and negative predictive value of 87.5%(95% CI=77.5%-93.4%)).Conclusion:1.INR significantly increased in early adult patients with nonpulmonary sepsis.2.The diagnosis of sepsis requires high vigilance when nonpulmonary infection is suspected and INR is above the optimal cut-off value(1.22).In addition,INR is significantly better than WBC?NLCR?PLT?PT and qSOFA in the early diagnosis of adult nonpulmonary sepsis.