The Relationship Between Etiological Types And Coagulation Dysfunction And Their Influence On Prognosis In Sepsis Caused By Bloodstream Infection

Objective:To explore the relationship between etiological types and coagulation dysfunction and their influence on prognosis in patients with sepsis caused by bloodstream infection in intensive care unit,so as to provide clues for the treatment and the evaluation of the prognosis of sepsis.Methods:From October 1,2017 to February 28,2019,a total of 169 sepsis and positive blood culture admitted to the department of critical care of the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively.According to the inclusion and exclusion criteria,93 patients were finally included.The baseline clinical data of the patients were collected in the study,including:gender,age,previous basic disease,primary infection site,prognosis within 28 days after admission to ICU,Acute Physiological and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score and Sequential Organ Failure Assessment(SOFA)score within 24 hours after admission to ICU,and within 48 hours Activated Partial Thromboplastin Time(APTT),Prothrombin Time(PT),International Normalized Ratio(INR)Thrombin Time(TT),Fibrinogen(FIB),Platelet count(PLT),and blood pathogen culture results.According to the results of blood culture,the patients were divided into Gram-negative bacteria(G~-)group,Gram-positive bacteria(G~+)group and fungus group.All the patients were infected by single pathogen.According to the prognosis within 28 days after admission to ICU,the patients were divided into survival group and death group.SPSS software was used to analyze the data collected.Results:1.In this study,a total of 93 patients with blood culture positive sepsis were included,and the proportion of G~-bacterial infection,G~+bacterial infection and fungal infection respectively were 53.76%,37.64%and 8.60%.G~-infection was mainly caused by Escherichia coli,Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa.The proportion of G~-bacterial infection was the highest.Staphylococcus capitatus,Staphylococcus haemolyticus and Staphylococcus hominis were the main pathogens of G~+bacteria infection.The main fungal infection were Candida.2.In the comparison of G~-bacteria group,G~+bacteria group and fungus group,there were differences in PLT,PT and INR among the three group.Further comparison showed that the PLT level of the G~-bacteria group was significantly lower than that of the G~+bacteria group[69.4(37.0,117.2)VS95.9(65.8,317.6)],while the PT and INR of the G~-bacteria group were longer than that of the G~+bacteria group(18.0±6.9 VS 14.7±3.8;1.51±0.58 VS1.23±0.32),which was statistically significant(P<0.05).There was no difference in PLT,PT and INR between fungi group and G~-bacteria group or G~+bacteria group.There was no difference between fungus group and G~-bacteria group or G~+bacteria group.There was no significant difference in gender,age,basic diseases,APTT,TT and FIB among three groups(P>0.05).3.Among the 93 patients in this study,57 survived and 36 died,with a mortality rate of 38.7%.Within 28 days after admission to ICU,the mortality rates of patients in G~-bacteria group,G~+bacteria group and fungus group were44.0%,31.4%and 37.5%,respectively.The mortality rates of the three groups showed no significant difference and statistical significance.Compared with the survival group,the levels of PT,INR and PCT in the death group were higher than that in the survival group[18.9±7.5 VS 15.1±3.9,1.58±0.63 VS 1.27±0.33,10.568(3.190,32.80)VS 1.920(0.342,21.240)]and the level of PLT in the death group was lower than that in the survival group[71.8(38.8,97.4)VS89.6(59.7,296.5)],with statistically significant differences(P<0.05).The age and APACHE Ⅱ score of the death group were higher than those of the survival group(61.47±15.00 VS 54.39±15.58,23±8 VS 16±7),the difference was statistically significant(P<0.05);there was no significant difference in gender,APTT,TT and FIB between the two groups(P>0.05).The results of correlation analysis showed that PT,INR were positively correlated with APACHE Ⅱ score,and PLT was negatively correlated with APACHE Ⅱ score.The results of ROC curve showed that the area under ROC curve of PT,INR and PLT were 0.667,0.668 and 0.635,which indicated that they had a certain predictive ability for the prognosis of sepsis patients;when PT was 15.05,the sensitivity and specificity of the death of sepsis due to bloodstream infection were 63.9%and 66.7%;when INR was 1.27,the sensitivity and specificity of the death of sepsis due to bloodstream infection were 63.9%,66.7%;When PLT was 80.8×10?9/L,the sensitivity and specificity of the death of sepsis due to bloodstream infection were 69.4%and 63.2%.4.Logistic multivariate regression analysis showed that age,APACHE Ⅱ score and INR were the risk factors of death within 28 days after admission to ICU(P=0.031,OR=1.042,95%CI:1.004-1.081;P=0.043,OR=1.074,95%CI:1.002-1.150;P=0.017,OR=5.280,95%CI:1.349-20.66).Conclusion:Compared with G~+bacteria and fungi,the prolongation of PT,INR and the decrease of PLT are most obvious in sepsis due to G~-bacterial bloodstream infection,which are the risk factors of death in patients with sepsis due to bloodstream infection.