To Evaluate The Value Of Arterial To End-tidal Carbon Dioxide Tension Difference Combine With Neutrophil-to-Lymphocyte Ratio For Adverse Outcomes In Sepsis

Background and Objective:Sepsis is a clinical syndrome caused by infection,which can conceal the onset of the disease and has a variety of clinical manifestations and a lack of specificity.Therefore,there is no histological diagnosis and reliable serological detection.Therefore,it is difficult to identify sepsis early in clinical work and quickly estimate the severity of the patient's condition.After the sepsis-3,a new round of study on various scoring systems and serological test was started in order to flind out the most suitable monitoring and assessment tools for clinical application.Studies have shown that P_a-ETCO₂ can reflect the degree of lung ventilation and blood ratio imbalance and indirectly reflect the dysfunction of respiratory and circulatory system.NLCR is a combination of active and adaptive immune response,while the pro-inflammatory and anti-inflammatory responses of the body in sepsis are co-occurring,thus reflecting the autoimmune status of sepsis.The purpose of this experiment is to test the predictive ability of P_a-ETCO₂ and NLCR to the adverse outcomes of sepsis,and to explore whether the combination of P_a-ETCO₂ and NLCR can improve the judgment ability of the adverse outcomes of sepsis.Methods:patients with sepsis admitted to the emergency ward and emergency intensive care unit of affiliated hospital of Hebei university on December 1,2018 to September 30,2019 were collected.P_a-ETCO₂,NLCR and qSOFA score were detected and recorded within2h after diagnosis of sepsis,and PCT,CRP,Lac,SOFA score and APACH-?score were recorded within 24h after diagnosis.According to the etiology,the patients were divide into pulmonary infection sepsis group and non-pulmonary infection sepsis group.Patients were divided into the survival group and the death group according to the 28 days survival after diagnosis of sepsis.To compare the difference of biomarkers and disease scores between the two groups of sepsis survival and death.Logistic regression was used to analyze the relationship between biomarkers and disease scores and poor prognosis of sepsis.Roc curve was drawn to test the ability of each biomarker and disease score to judge the poor prognosis of sepsis.Logistic regression was used to make P_a-ETCO₂ and NLCR joint predictors,and Roc curve was drawn to test the predictive accuracy of joint predictors.SOFA score was used as the standard for severity of sepsis,and spearman correlation analysis was performed to test the correlation between P_a-ETCO₂ and NLCR and combined predictor and SOFA score.Results:?1?P_a-ETCO₂ is a risk predictor for adverse outcome of non-pulmonary infection sepsis?OR=1.952,95%CI:1.302².927,P<0.001?,the ability to assess is good?AUC=0.891,P<0.001?,batter than PCT?AUC=0.788,P=0.001?,CRP?AUC=0.826,P=0.012?,Lac?AUC=0.854,P<0.001?;P_a-ETCO₂ is not a risk predictor for adverse outcome of pulmonary infection sepsis?OR=1.073,95%CI:0.980¹.176,P=0.129?,inability to assess prognosis?AUC=0.735,P=0.067?;?2?NLCR is a risk predictor for adverse outcome of sepsis,for all sepsis?OR=1.151,95%CI:1.070¹.238,P<0.001?,for non-pulmonary infection sepsis?OR=1.154,95%CI:1.049¹.269,P=0.003?,for pulmonary infection sepsis?OR=1.180,95%CI:1.025¹.359,P=0.022?,the ability of prognosis for all sepsis?AUC=0.829,P=0.003?for non-pulmonary infection sepsis?AUC=0.861,P<0.001?,for pulmonary infection sepsis?AUC=0.844,P=0.007?,NLCR is comparable to PCT,CRP and Lac in predicting prognosis in each group;?3?The combined predictor of P_a-ETCO₂ and NLCR has high predictive value for adverse outcome of non-pulmonary infection sepsis?AUC=0.968,P<0.001,sensitivity=88.2%,specificity=92.9%?.?4?P_a-ETCO₂ is slightly correlated with SOFA score?rs=0.489,P=0.001?,NLCR is moderately correlated with SOFA score?rs=0.621,P<0.001?,the correlation between the joint predictor and SOFA score is strongest?rs=0.679,P<0.001?.Conclusion1.P_a-ETCO₂ has a good evaluation effect on the adverse outcome of non-pulmonaryinfection sepsis,but it is inability to evaluate the poor prognosis of pulmonary infection sepsis.2.NLCR is of value evaluating the adverse outcome of sepsis caused by differentetiologies.3.The combined predictor of P_a-ETCO₂ and NLCR has high predictive value for adverseoutcome of non-pulmonary infection sepsis.4.The combined predictor of P_a-ETCO₂ and NLCR can reflect severity of sepsis ofnon-pulmonary infection sepsis.