Analysis Of Prognostic Factors In Elderly Patients With Sepsis/Septic Shock

Objective To study the expression and significance of a series of serum biochemical indicators and immune related factors of elderly sepsis/septic shock patients,as well as sepsis-related organ failure assessment score(SOFA)and acute physiology and chronic health valuation(APACHE?),so as to support theoretical bases and prognosis assessments in clinical diagnosis for elderly sepsis/septic shock patients.Methods Based on historic cohort study,405 elderly sepsis patients and 49 elderly medical examinees followed up in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine during 2016 — 2018 were included.The differences in expression levels of serum biochemical factors,immune related factors,SOFA and APACHE?were compared between groups.Logistic regression analysis and ROC curve approaches were also used to reveal the predictive value of indicators in prognosis assessments for elderly sepsis/septic shock patients.Results 1.The expression levels of C-reaction protein(CRP),procalcitonin(PCT),N-terminal pronatriuretic peptide(NT-proBNP),D-Dimer and Leukocyte count in sepsis patients were significantly higher than those in normal examinees.And the expression levels of PCT,D-Dimer,Lactic acid,Interleukin-10(IL-10),SOFA and APACHE? in sepsis shock patients were significantly higher than those in sepsis patients.2.The expression levels of CRP,NT-proBNP,D-dimer,Il-10,SOFA and APACHE? in dead patients were significantly higher than those in survivalpatients,while the expression level Interleukin-8(IL-8)was opposite.3.Logistic regression analysis showed that the age of patients,the expression levels of NT-proBNP,IL-8,IL-10 and SOFA were risk factors for predicting death of elderly patients with sepsis.4.The ROC curves demonstrated that age,NT-proBNP,IL-10 and SOFA were the independent prognostic risk factors for the death of elderly sepsis patients.The areas under the curves about age,NT-proBNP,IL-8,IL-10 and SOFA 0.589,0.628,0.563,0.598 and0.713,which proved SOFA was the most predictive factor.Cut-point analysis proved that age > 73.5,IL-8 < 8.07 pg/mL,IL-10 > 9.265 pg/ml,NT-proBNP > 1345 pg/ml,SOFA >5.50 made a high sensitivity and specificity in the death of elderly patients with sepsis.The area under the curve of the combination of IL-8,IL-10,NT-proBNP and SOFA was the highest(95% CI:0.753-0.843),which was even higher than that of all five indicators.Conclusion Age,NT-proBNP,IL-8,IL-10 and SOFA were the independent prognostic risk factors for the death of elderly sepsis patients.The combination of NT-proBNP,IL-8,IL-10 and SOFA had a certain reference significance for the diagnosis of elderly sepsis.