Prognostic Factors In Patients With Septic Shock And Malignant Tumor

Objective:Septic shock is associated with a high risk of death in patients with malignant tumors.With the progress of medicine,the overall prognosis of patients with severe malignant tumor has improved,but in the intensive care unit,patients with septic shock still have a very high mortality.The purpose of this study is to discuss the prognostic factors of malignant tumor patients with septic shock,so that we can more timely evaluate the risk factors and clinical intervention in clinical work,so as to maximize the rehabilitation opportunities of patients.Methods:A total of 49 patients with septic shock admitted to the Department of critical care medicine of the Third Affiliated Hospital of Kunming Medical University(Yunnan Cancer Hospital)from May 2020 to January 2021 were selected.All subjects followed the inclusion and exclusion criteria.According to the 28 day outcome,the patients were divided into survival group and death group.The baseline of the subjects were recorded,including age,gender,BMI,HR,MAP,SOFA score,APACHEⅡ score,infection site,infection bacteria,tumor type,history of chemotherapy,28 day survival rate,etc.All subjects completed echocardiography examination 24 hours after the diagnosis of septic shock,and recorded relevant examination indexes,including left ventricular ejection fraction(LVEF),E/A,E/Em,tricuspid annular systolic displacement(TAPSE).At the same time,the blood related indexes including C-reactive protein(CRP),procalcitonin(PCT)and white blood cell count(WBC)were submitted within 24 hours;Myocardial markers:CK,CK-MB,HS-TNT;Heart failure marker:N-terminal pro-B-type natriuretic peptide(NT proBNP).SPSS 23.0 statistical software was used for data processing and statistical analysis.For the measurement data that accord with the normal distribution,the mean value±Standard deviation(x±s)is used.The independent sample t test was used to compare the data between the two groups.The measurement data of non normal distribution between the two groups were represented by median(interquartile interval)[M(QL,Qu)].The data between the two groups were compared by Mann Whitney U test.For counting data between two groups,we use χ2 test.For the analysis of nonlinear regression relationship between one dependent variable and multiple independent variables,binary logistic regression was used when the dependent variable was binomial.Receiver operating characteristic curve(ROC)and area under curve(AUC)were used to compare and analyze the predictive value of related indicators for patients’ outcomes.When P<0.05,the difference was statistically significant.Results:A total of 49 subjects were included in this study.According to their 28 day outcomes,they were divided into survival group(27 cases)and death group(22 cases).The results of statistical analysis were as follows:there were significant differences in age,HR,SOFA score,APACHE II and blood lactic acid between the two groups(P<0.05).There was no significant difference in gender,BMI,MAP,history of chemotherapy and etiology(P>0.05).There were significant differences in E/Em,Em and TAPSE between the two groups(P<0.05);There was no significant difference in E/A and LVEF between the two groups(P>0.05).The CK-MB and HS-TNT in the death group were higher than those in the survival group(P<0.05);There was no significant difference in other indexes such as NT proBNP,CRP,PCT,WBC and CK(P>0.05).Univariate logistic regression analysis was performed for the indexes with statistically significant differences in the above comparison.The results showed that age,HR,SOFA,APACHE Ⅱ,blood lactic acid and TAPSE were closely related to 28 day death(P<0.05).The results showed that APACHE Ⅱ(or=1.896,P=0.031)score and TAPSE(or=0.695,P=0.030)had significant effects on the outcome of patients with septic shock.Receiver operating characteristic curve(ROC)and area under curve(AUC)were used to evaluate the short-term prognosis of patients with septic shock.The area under the ROC curve(AUC)of APACHE Ⅱ score was 0.894(P=0.000),the sensitivity was 84.6%,the specificity was 73.9%,and the best critical value was 18.5.The area under the ROC curve(AUC)of TAPSE was 0.717(P=0.001),the sensitivity was 87.0%,the specificity was 57.7%,and the optimal critical value was 17.3 mm.Conclusion:1.Age,HR,SOFA score,APACHE II score,blood lactate,Em,E/Em,TAPSE,CK-MB,HS-TNT all affect the prognosis of patients with septic shock.2.APACHE Ⅱ score is an independent risk factor for short-term prognosis of patients with septic shock.TAPSE is an independent related factor for short-term prognosis of patients with septic shock.It plays a protective role in the prognosis of patients.Moreover,APACHE Ⅱ score and TAPSE are good predictors of prognosis.