Early Prediction Of The Severity Of Sepsis By Procalcitonin Combined With Thromboelastography And Platelet

BackgroundSepsis is been defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.The pathophysiology of sepsis is complex.Sepsis is the most common cause of death in intensive care units worldwide.Inflammation,infection,immunity and coagulation disorders are closely related to the occurrence and development of sepsis.Although traditional biomarkers such as procalcitonin(PCT),interleukin-6(IL-6),lactic acid(LAC),and C-reactive protein(CRP)can be used for the early diagnosis of sepsis,these biomarkers cannot reflect the severity of it.Previous studies have found that inflammatory reaction and coagulation function interact with each other in the development of sepsis.Inflammation is induced by the stimulation of pathogens in the early stage of sepsis,and vascular endothelial cells are damaged,which leads to platelet activation,resulting in blood hypercoagulabale and microvascular thrombosis.With the massive consumption of coagulation factors and the hyperfunction of fibrinolytic system,the blood becomes low coagulation state,which leads to bleeding and microcirculation disturbance.Thromboelastography(TEG)can not only evaluate the coagulation function at an early stage,but also provide all the information from coagulation initiation to platelet aggregation,and from blood clot formation to degradation.Therefore,early monitoring of TEG can find the coagulation disorder early.In addition,platelets also play an important role in the development of sepsis.According to statistics,at least 50%of sepsis patients will have decrease of platelet.To some extent,the number and function of platelets are indicative of the severity of the disease.Therefore,we speculate whether PCT reflecting the inflammatory reaction,can be combined with TEG and platelet reflecting the coagulation function,to predict the severity of sepsis in the early stage.ObjectiveTo explore the early predictive value of procalcitonin combined with thromboelastography and platelet in the severity of sepsisMethods1.Retrospective analysis was conducted on 175 patients who met the inclusion criteria and were admitted to the intensive care unit of Shandong Provincial Hospital from January 2017 to February 2021.They were divided into sepsis group and septic shock group according to The Third International Consensus Definitions of Sepsis and Septic Shock(Sepsis 3.0),proposed by the Society of Critical Care Medicine(SCCM)and the European Society of Intensive Care Medicine(ESICM)in 2016.2.Collect the baseline characteristics of patients,SOFA,general clinical data and related laboratory data.Include TEG,Lac,PCT,Plt,etc.3.All data were analyzed by SPSS26.0 statistical software.Independent sample T test,Pearson correlation test,Binary Logit regression and Receiver operator characteristic curve have been used.Results1.175 cases were included in this study.There was no significant difference in gender and age between the sepsis group and the septic shock group(P>0.05).In the sepsis group,50 cases(49.02%)improved and 52 cases(50.98%)died.In the septic shock group,21 cases(28.77%)were improved and 52 cases(71.23%)died,the difference was statistically significant(P<0.01).2.The SOFA,PCT,R and K in the septic shock group were higher than those in the sepsis group,which were(12.74±3.73)vs.(5.95±3.09),(21.55±29.15 ng/ml)vs.(9.28±20.97 ng/ml),(9.09±4.89 min)vs.(6.80±2.90 min),(3.76±3.34 min)vs.(2.11± 1.53 min)with statistically significant difference(p<0.01).2)Platelet,a angle,MA and CI in the septic shock group were all lower than those in the sepsis group(96.33±94.68 x 10^9/L)vs.(183.12±161.84 x 10^9/L),(55.69±15.50 deg)vs.(64.76±10.77 deg),(52.16±14.06)vs.(60.87±11.40),(-4.10±5.81)vs.(-0.64±3.68),with statistically significant difference(p<0.01).3.With the severity as the dependent variable,the binary Logit regression analysis was conducted with PCT,TEG,Plt,PCT combined with TEG and Plt as the independent variables,and the area under the ROC curve was detected.The model formula is as follows:In(p/1-p)=-4.877+0.007 x pct+0.229 x CI+0.275 x R+0.6 x K+0.057 x α-0.028 x MA-0.005 x Plt(P represents the probability of septic shock,1-p represents the probability of sepsis).The area under the ROC curve(AUC)of PCT combined with TEG and Plt was 0.760(95%CI,0.685-0.834),sensitivity was 80.7%,specificity was 81.6%.The AUC of PCT was 0.760(95%CI,0.690-0.830),sensitivity was 62.3%,specificity was 67%.The AUC of TEG was 0.717(95%CI,0.635-0.799),sensitivity was 68.4%,specificity was 73.8%.The AUC of Plt was 0.279(95%CI,0.201-0.358),sensitivity was 72.8%,specificity was 62.5%.Conclusions1.Procalcitonin combined with thromboelastography and platelet has high value in predicting the severity of sepsis in early stage,and has high sensitivity and specificity.It is better than single index prediction.2.PCT,TEG,Plt have a certain correlation with the severity of sepsis.R,K or PCT is positively correlated with the severity of sepsis.The higher the value,the more serious the sepsis is,and the greater the possibility of developing into septic shock.MA or CI or α angle or Plt is negatively correlated with the severity of sepsis.The lower the value,the more severe the sepsis,and the greater the possibility of developing into septic shock.