Study On The Correlation Between Pathogenic Types And Traditional Chinese Medicine Syndromes In Patients With Bloodstream Infection And Sepsis

ObjectiveTo investigate the distribution characteristics of Traditional Chinese Medicine syndromes in patients with sepsis due to bloodstream infection and its relationship with pathogen types,PCT level and prognosis,so as to provide reference for TCM syndrome differentiation and treatment.And to analyze the differences of PCT and other related indexes in sepsis patients with bloodstream infection caused by different pathogens,so as to provide reference for early identification of bloodstream infection pathogens.MethodsThis is a retrospective cross-sectional observational study.Clinical data of 172 septic patients with bloodstream infection hospitalized in Guangdong Provincial Hospital of traditional Chinese medicine from April 2017 to June 2019 were collected,including general condition,symptoms,signs,blood culture results,PCT and other laboratory indicators,APACHE Ⅱ score,SOFA score,7-day mortality,28 day mortality and other indicators.According to the clinical symptoms,the syndrome differentiation was determined by more than two deputy chief physicians according to the standard of yin and Yang syndrome differentiation.The differences of etiology,laboratory indexes,scores and prognosis were compared between the two groups.SPSS 17.0 was used for statistical analysis.Chi square test or Fisher exact test were used to compare the counting data.The measurement data in accordance with the normal distribution is expressed as mean ±standard deviation,and those not in accordance with the normal distribution are expressed as median(quartile).For comparison between the two groups,t-test was used for those who were in accordance with normal distribution and homogeneity of variance(homogeneity test level a=0.10),while nonparametric test was used for those who were not in accordance with normal distribution and homogeneity of variance.For comparison among multiple groups,univariate analysis of variance was used if the variance was homogeneous,and Welch analysis of variance was used if the variance was uneven.Binary logistic regression was used to evaluate the relationship between related indicators and classification results.Test level α=0.05.Results1.A total of 172 patients with hematogenous sepsis were included,including 58 cases of Yin Syndrome and 114 cases of Yang syndrome.There was no significant difference in gender,age,smoking,drinking and basic diseases between the two groups(P>0.05).2.According to the syndrome differentiation of yin and Yang,the indexes between the two groups were compared.RBC,Hb,HCT,ALB,IBIL,Urea,DBP and MAP of Yin Syndrome group were lower than those of Yang syndrome group,while PCO2,SOFA score and APACHE Ⅱ score of Yin Syndrome group were higher than those of Yang syndrome group(P<0.05),but there was no significant difference in PCT between the two groups(P>0.05).The hospitalization cost,length of stay,length of stay in ICU,the proportion of ICU stay,the proportion of using mechanical ventilation and the proportion of using vasoactive drugs in the Yin Syndrome group were significantly higher than those in the Yang syndrome group,and the in-hospital mortality and 28 day mortality were also significantly higher than those in the Yang syndrome group.(P<0.05)3.Pulmonary infection is the most common site of concurrent infection in patients with hematogenous sepsis.Bacteria are the main pathogens of infection,and G-bacteria account for the largest proportion.There was a significant difference in bacterial resistance between the two groups.The proportion of multi drug resistant bacteria in the Yin Syndrome group was higher than that in the Yang syndrome group,while the proportion of sensitive bacteria was lower than that in the Yang syndrome group(P<0.05).The most common pathogenic bacteria in the two groups were Escherichia coli.There was significant difference in the proportion of Acinetobacter baumannii and Escherichia coli infection between the two groups.The proportion of blood infection caused by Acinetobacter baumannii was higher in the Yin syndrome group,and the proportion of blood infection caused by Escherichia coli was higher in the Yang Syndrome group(P<0.05).4.After adjusting for related factors,multivariate logistic regression analysis showed that MAP≥80(OR=3.409,95%CI[1.450,8.011]),ALB≥32(OR=3.584,95%CI[1.539,8.346])and blood culture results showed that Escherichia coli(OR=2.618,95%CI[1.045,6.564])were positively correlated with blood infection sepsis of Yang Syndrome(all P<0.05).Age(OR=1.056,95%CI[1.015,1.098]),SOFA score(OR=1.275,95%CI[1.088,1.493])and the use of vasoactive drugs(OR=3.532,95%CI[1.247,10.006])were positively correlated with the overall in-hospital mortality,and blood borne infection caused by sensitive bacteria(OR=0.184,95%CI[0.041,0.823])were negatively correlated with the overall in-hospital mortality(P<0.05).In subgroup analysis,SOFA score(OR=1.412,95%CI[1.123,1.774])was positively correlated with in-hospital mortality in Yin Syndrome group,while Lac(OR=1.409,95%CI[1.052,1.886])and blood borne infection caused by Pseudomonas aeruginosa(OR=12.508,95%CI[0.989158.229])were negatively correlated with in-hospital mortality in Yang syndrome group(P<0.05).5.To analyze the patients with single pathogen bloodstream infection,the PCT and the proportion of using vasoactive drugs in G-bacteria group were significantly higher than those in G+bacteria group,LDH and cTnT were significantly lower than those in G-bacteria group(P<0.05).Further regression analysis showed that PCT(OR=1.017,95%CI[1.001,1.034])was positively correlated with g-bacterial bloodstream infection sepsis,cTnT was negatively correlated with g-bacterial bloodstream infection sepsis(OR=0.034,95%CI[0.005,0.806])(P<0.05).Conclusion1.The yin-yang syndrome of septic patients with bloodstream infection is related to the condition and prognosis of sepsis,and also related to the type of etiology,but has no significant relationship with the level of PCT.2.ALB,MAP and Escherichia coli bloodstream infection can be used as the basis of Yin-Yang syndrome differentiation in septic patients with bloodstream infection,but further multicenter,large sample prospective trials are needed to verify.3.There was significant difference in PCT between sepsis patients with bloodstream infection caused by G-bacteria and G+bacteria,and it can be used as a biomarker to identify the types of bacteria in septic patients with bloodstream infection.