| Objective:To detect and collect in admitted to intensive care department who were senile patients ≥60 years old of the neutrophils CD64 index(n CD64),interleukin-6(IL-6)and White blood cell count(WBC),Serum amyloid-a(SAA),C-reactive protein(CRP)and Procalcitonin(PCT).their values in the diagnosis and assessment of the severity of sepsis in elderly patients were analyzed and compared.Methods:A retrospective case-control study was conducted to collect n CD64,WBC,CRP,PCT,SAA,IL-6 of 136 cases elderly patients with hospitalization time ≥24h and age ≥60,whose were admitted to the Department of Critical Care Medicine from January 2021 to July 2022.Acute Physiology and Chronic Health Score II(APACHEII),sequential organ failure score(SOFA),age,sex,Body mass index(BMI),hospitalization time,Whether to carry out continuous renal replacement therapy(CRRT)and whether mechanical ventilation is needed.According to the diagnostic criteria of sepsis(sepsis 3.0),they were divided into non-sepsis(60 cases)and sepsis group(76cases).According to the severity of the elderly patients with sepsis(whether septic shock occurred within 28 days),they were divided into sepsis group(36 cases)and septic shock group(40 cases).The infection site and pathogenic results of sepsis group were counted.Multivariate logistic regression was used to analyze the risk factors affecting elderly patients with sepsis,and receiver operating characteristic curve(ROC)was drawn to analyze the application value of n CD64 and other indicators in the diagnosis and condition evaluation of elderly patients with sepsis.Results: 1.Comparison of general data between non-sepsis group and sepsis group,There were 31 males and 29 females in non-sepsis group(60 cases).There were 42 males and 34 females in sepsis group(76 cases).non-sepsis group vs sepsis group age[71(62,74.75)vs 74(68,79)](P = 0.000).PCT[2.94(1.72,4.29)vs 10.15(2.3,35.65)](P=0.000).SAA[64.58(60.79,69.04)vs 87.5(57.55,151.325)](P=0.000).IL-6[292.5(235.25,370)vs 404.5(243.75,999.67)](P=0.018).n CD64[2.3(1.72,3.08)vs 5.11(2.78,6.97)](P=0.000).BMI[22.45(20.45,24.47)vs 20.2(18.2,23.47)](P=0.006).APACHEII score[11.5(10,19)vs 15(10,19)](P = 0.038).SOFA score[10(6,12)vs 11(8,14)](P = 0.010),with statistical difference(P < 0.05).There was no statistical difference between the two groups in gender,whether WBC,CRP and CRRT were used or not,whether mechanical ventilation was needed and the length of hospital stay(P > 0.05).Comparison of general data between septic group and septic shock group,There are 17 males and 19 females in the sepsis group(36 cases).In septic shock group(40 cases),there were 25 males and15 females.WBC[0.89(3.45,14.22)vs 13.43(4.59,19.95)](P=0.022).IL-6[252.7(240.25,699.4)vs 627.5(287.63,1197.5)](P=0.001).CRP[120.85(65.44,202.86)vs 264.6(134.4,311.33)](P=0.022).n CD64[3.66(2.1,4.94)vs 6.55(4.78,9.1)](P=0.000).PCT[6.09(2.01,10.27)vs 33.19(8.73,47.63)](P=0.000).APACHEII score[10(7.13,13.75)vs 17.5(15,21)](P = 0.000).SOFA score[10(7.25,13)vs 12(10.25,14)](P = 0.026),The data was statistically significant(P < 0.05).There was no significant difference in sex,age,BMI,SAA,infection site,hospital stay,CRRT treatment and whether mechanical ventilation was needed between the two groups(P >0.05).Distribution of pathogens in sepsis group,distribution of pathogens in sepsis group(36 cases)among them,there were 18 cases of gram-positive bacteria,16 cases of gram-negative bacteria,2 cases of fungi and 6 cases of mixed infection.Distribution of pathogens in septic shock group(40 cases)Gram-positive bacteria in 11 cases and Gram-negative bacteria in 29 cases,including 9 cases of mixed infection.2.By multivariate logistic regression analysis non-sepsis group and sepsic group,age,PCT,SAA,n CD64,APACHEII score are the risk factors of sepsis in elderly patients.Age of elderly patients[95% CI 1.067 ～ 1.368,OR=1.208,P = 0.003],n CD 64 [95%CI 1.654 ～ 5.389,OR=2.978,P = 0.000],PCT[95% CI 1.212 ～ 2.333,OR=0.798,P =0.048].SAA [95% CI 1.019 ～ 1.084,OR=1.051,P= 0.002],APACHEII score [95%CI 0.638 ～ 0.998,OR=0.798,P = 0.048].Using multivariate logistic regression analysis sepsis group and septic shock group,APACHEII score,PCT and n CD64 are the risk factors that affect the severity of the elderly patients with sepsis.APCHEII score[95%CI 1.040 ～ 1.664,OR=1.315,P = 0.022].PCT[95% CI 1.000 ～ 1.004,OR=1.002,P =0.032].n CD64[95% CI 1.267 ～ 2.834,OR=1.895,P = 0.002].3.Using receiver operating characteristic curve(ROC)analysis non-sepsis and sepsis,age,SAA,PCT and n CD64(AUC)were 0.676,0.691,0.75 and 0.811 respectively.The specificity was 68.3%,85.0%,96.7% and 90% respectively.The sensitivities were57.9%,64.5%,64.5% and 68.4% respectively.The cut-off were 72.5,72.625,6.205 and3.74 respectively.Age[95% CI 0.586 ～ 0.766,P = 0.000].SAA[95% CI 0.595 ～ 0.786,P = 0.000].PCT[95% CI 0.663 ～ 0.837,P = 0.000].n CD64[95% CI 0.738 ～ 0.883,P = 0.000].The highest specificity is PCT,and the highest sensitivity is n CD64.Using receiver operating characteristic curve(ROC)analysis sepsis group and septic shock group,n CD64,PCT,n CD64 and PCT,APACHEII score between septic group and septic shock group.The area under(AUC)were 0.818,0.789,0.949 and 0.874 respectively,with sensitivity of 82.5%,67.5%,97.5% and 90.0%,respectively.n CD64[95% CI 0.699 ～ 0.904,P = 0.000 ],PCT[95% CI 0.678 ～ 0.900,P = 0.000]PCT+n CD64[95% CI 0.902 ～ 0.996,P = 0.000],APACHEII score[95% CI 0.791 ～0.959,P = 0.000].The area under(AUC)of n CD64 is higher than that of PCT and lower than APACHEII score,and the area under(AUC)of n CD64 combined with PCT index is higher than that of single index.Conclusion: Age,n CD64,PCT,SAA and APACHEII scores are the risk factors of sepsis in elderly patients.SAA,PCT and n CD64 have high specificity for the diagnosis of elderly patients with sepsis,but their sensitivity is average.n CD64,PCT and APACHEII scores are independent risk factors affecting the severity of sepsis in the elderly.The area under(AUC)of n CD64 is higher than that of PCT and lower than APACHEII score,and the area under(AUC)of n CD64 combined with PCT index is higher than that of single index.The scores of n CD64,PCT and APACHEII score are the risk factors of susceptibility to sepsis in the elderly,and they are also the risk factors that affect the severity of sepsis in the elderly. |
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