Clinical Characteristics And Prognostic Correlation Analysis Of Sepsis Patients In ICU With High Plasma Procalcitonin Level

Objective:To investigate the clinical characteristics and the prognostic correlations of sepsis patients in ICU with high levels of plasma procalcitonin（PCT）.Methods:Retrospective analysis was used to collect the basic data of patients,including gender,age,underlying diseases,complications.The critical illness score including Glasgow Coma Score（GCS score）,acute physiology and chronic health score system Ⅱ（APACHE Ⅱ score）,sequential organ failure score（SOFA score） and Charlson complication index score（CCI） were also collected.Vital signs,arterial blood gas analysis,blood routine,liver and kidney function,blood electrolytes,blood glucose,coagulation function,myocardial enzyme spectrum and bacterial culture results of blood,urine,sputum and catheter samples were recorded.All eligible patients were divided into high PCT group（PCT>100μg/L）and low PCT group（PCT=0.02～100μg/L）,and the differences of the above indexes in high PCT group and low PCT group were compared respectively;then the two groups were divided into 28 day survival group and 28 day death group,and the differences of the above indexes in 28 day survival group and 28 day death group were compared respectively.The influencing factors were included in the regression model.Binary logistic regression analysis was used to screen the risk factors for prognosis.The ROC curve of each index was drawn.The area under the curve,the best cut-off value,sensitivity and specificity of each index were calculated.Comparing the predictive value of each index for 28d prognosis of sepsis patients.Analyzing the correlation between independent risk factors and 28 d mortality in two groups.Drawing scatter plot and linear correlation fitting and Lowess fitting were performed.Results:1.A total of 296 patients were included in this study,103 in high PCT group and 193in low PCT group.Compared with the low PCT group,the average age of the high PCT group was younger;the proportion of patients with a history of major surgery 7days before admission and during hospitalization was higher;APACHE Ⅱ score,SOFA score were significantly higher,CCI score was significantly lower;The proportion of AKI stage 1 was lower;the proportions of AKI stage 2,AKI stage 3 and renal replacement therapy were higher;The levels of HR,Lac,PaCO₂,HCO₃^-,Sa O₂,IL-6,CRP,AST,LDH,BUN,CREA,PT,APTT,INR,D-D,cTnI,Myo and CK-MB were significantly increased;PH,Plt and i Ca²⁺ were significantly decreased（all P<0.05）.2.In the low PCT group,comparing with the 28d survival group,the proportion of male in the 28d dead group was higher,the proportion of shock was higher,and the number of underlying diseases was more;GCS score,APACHE Ⅱ score,SOFA socore and CCI score were higher;The proportions of AKI stage 3 and renal replacement therapy were higher;The blood infection rate is higher;The levels HR,RR,Lac,BE,Ly%,AST,LDH,BUN,CREA,PT,INR,c Tn I,Myo,CK-MB,K⁺and Glu were significantly increased,MAP,PH,Pa O₂,HCO₃^-,SpO₂,SaO₂ and Alb were significantly decreased（all P<0.05）.The independent risk factors of 28d prognosis were SOFA socore,CCI score,HCO₃^-,SaO₂ and LDH.They were all of diagnostic significance for 28 day prognosis of adult sepsis patients with low plasma PCT in ICU（all AUC>0.5）.The sensitivity of SOFA score was the highest（80.9%）,and the specificity of HCO₃^- and SaO₂ were the highest（90.9%）.There were linear correlations between the independent risk factors of 28d prognosis and 28d mortality（all P<0.0001）.3.In the high PCT group,comparing with the 28d survival group,the proportion of shock in the 28d dead group was higher;GCS score,APACHE Ⅱ score,SOFA score were higher;the proportion of AKI stage 1 was lower,and the proportion of AKI stage 3 was higher;the infection rate of gram-negative bacilli was significantly increased;The levels of Lac,APTT,c Tn I,Myo,Na⁺and Glu were significantly increased;The levels of HCO₃^-,Sp O₂ and SaO₂ were significantly decreased（all P<0.05）.APACHE Ⅱ score was an independent risk factor for the 28d prognosis of this kind of patients.It had diagnostic significance for the prognosis of adult sepsis patients with high plasma PCT in ICU（AUC>0.5）with the sensitivity and specificity of 87%and 80.7%.There was a linear correlation between the independent risk factor of 28d prognosis and 28d mortality（P<0.0001）.Conclusion:Sepsis patients in ICU with high plasma PCT levels were mostly middle-aged and elderly men with a high incidence of shock,whose GCS,APACHE Ⅱ and SOFA scores increased.Compared with ICU patients with low plasma PCT,ICU patients with high plasma PCT had higher deterioration of heart function,lung function,liver function,kidney function and coagulation function.The prognosis of sepsis patients with high PCT level was related to shock,GCS score,APACHE Ⅱ score,SOFA score,AKI stage 3,oxygen saturation,lactic acid level,metabolic acidosis,myocardial enzymes,coagulation function,electrolytes,glucose and gram-negative bacilli infection.APACHE Ⅱ score was an independent risk factor for the 28d prognosis of sepsis patients in ICU with high plasma PCT levels.