Study On The Severity And Prognosis Of Neonatal Sepsis By Lactic Acid Clearance Combined With Coagulation Function Test

Objective By analyzing the relationship between arterial lactic acid(LAC),lactic clearance rate(LCR),coagulation function indicators and the prognosis of Neonatal sepsis(NS),to explore the value of LCR combined with coagulation function test in evaluating the severity and prognosis of neonatal sepsis.Methods According to the inclusion and exclusion criteria,a total of 52 neonatal patients with sepsis admitted in the neonatal intensive care unit(NICU)Affiliated Hospital of Yangzhou University between November 2021 and December 2022 were selected as the sepsis group,and 50 neonatal patients without infectious diseases were selected as the non-sepsis group.According to neonatal critical cases scoring method(Neonatal critical illness score,NCIS)and critically ill newborn monomial index score into non critical groups,critical,extremely critical group.According to the prognosis,the children were divided into good prognosis group and poor prognosis group.The differences of initial LAC,LCR,coagulation function and other indicators in each group were compared,and binary Logistic multivariate regression analysis was performed to screen out statistically significant variables.Evaluation of each index with NS,the relationship between disease and prognosis through the receiver-operating characteristic curve(ROC)to calculate the index of the area under the curve(AUC)and draw a diagram,in order to evaluate the value of each index for the early prediction,severity and prognosis of NS.Results 1.General information: There were no significant differences in gestational age,birth weight,gender,age of admission,mode of delivery and maternal pregnancy-related diseases among all groups(P>0.05).2.Early prediction of LAC,coagulation function of NS: Compared with the non-sepsis group,prothrombin time(PT)and international normalized ratio(INR)of newborn infants in the sepsis group were significantly prolonged.D-dimer(D-D)was significantly increased(P<0.05),initial LAC was significantly increased,and LCR level was significantly decreased(P<0.05);Binary Logistic multivariate regression analysis showed that LCR and D-D were independent risk factors for NS,and the best truncation values of LCR and D-D for NS prediction were 16.67%and 2.45mg/L,respectively.The AUC of the combined prediction of LCR and D-D was the maximum,0.77,and the maximum approximate entry index was 0.41.The sensitivity was 75%and the specificity was 66%.3.LAC,coagulation function and other indexes and critical degree evaluation of NS:Compared with non-critical group,D-D of neonates in critical group and extremely critical group was significantly increased(P<0.05),initial LAC was significantly increased,and LCR level was significantly decreased(P<0.05);compared with the critical group,the initial LAC was significantly increased,the LCR level was significantly decreased,and the D-D level was significantly increased in the extremely critical group(P<0.05).There was no statistical significance in the initial LAC,LCR and D-D between the non-critical group and the critical group(P>0.05).4.Prognosis assessment of LAC,coagulation function and other indicators and NS:compared with good prognosis groups,poor prognosis group activated partial prothrombin time(APTT)significantly prolong and D-D significantly higher(P<0.05),the initial LAC obviously increases,the LCR level significantly decreased(P<0.05);Binary Logistic multivariate regression analysis showed that LCR and D-D were independent risk factors for poor prognosis of NS,and the best truncation values of LCR and D-D for poor prognosis of NS were 37.5%,3.13mg/L,respectively.The AUC predicted by the combination of the two was 0.904,the maximum approximate entry index was 0.663,the sensitivity was 72.22%,and the specificity was 94.12%.Conclusions 1.Neonatal sepsis is prone to increased LAC,decreased LCR and abnormal coagulation function,and the combined detection of LCR and D-D has a certain predictive effect on NS.2.The more severe the NS infection was,the more obvious the abnormal coagulation function was changed,the higher the LAC level was,and the lower the LCR was.3.The worse the prognosis of NS,the lower the LCR and the more obvious the abnormal coagulation function index.The combined detection of LCR and D-D has certain reference value for evaluating the prognosis of NS.4.The detection of neonatal coagulation function combined with LCR can provide reference for the evaluation of the severity and prognosis of NS.