Predictive Value Of Erythrocyte Distribution Width To Platelet Ratio In Combination With Lactate,APACHE Ⅱ Score And D-dimer In Septic Shock

Objective:To investigate the predictive value of red blood cell distribution width(RDW)to platelet count(PLT)ratio(RPR)for Predictive value of prognostic assessment of sepsis in combination with lactate,acute physiological and chronic health score II(APACHEⅡ),and D-dimer for septic shock.Methods:This was a retrospective study to collect clinical data of 131 patients with sepsis admitted to Shanxi Provincial People’s Hospital from January 2019 to December 2021.Patients included in the study were divided into a septic non-shock group(n=69)and a septic shock group(n=62)according to Sepsis 3.0 diagnostic criteria.General data of patients,in-hospital data at 24 hour of admission were collected and the differences in variables between the two groups were compared,and differences were considered statistically significant at P < 0.05.Binary logistic regression was used to analyze the independent risk factors for the development of septic shock in patients with sepsis.Subject Operating Characteristic(ROC)curves were further used and the area under the curve(AUC)was calculated to analyze the efficacy of RPR,lactate,APACHE II score,D-dimer and the combination of the four in predicting the development of septic shock in septic patients.Results:A total of 131 patients were included,including 74 males and 57 females;compared with the septic non-shock group,patients in the septic shock group had increased heart rate,SOFA score,APACHE II score,RPR,lactate,PCT,D-dimer,and BNP,and decreased MAP,platelet pressure product,and PLT,all with statistically significant differences(P<0.05).Multi-factor logistic regression analysis showed that RPR,lactate,APACHE II score,and D-dimer were all independent risk factors for septic shock in septic patients(P<0.05).The ROC curve analysis showed that the AUC of RPR for septic shock was 0.676 with a sensitivity of 80.5% and specificity of 49.3%,suggesting a prediction threshold of0.085.The AUC of lactate was 0.710 with a sensitivity of 82.3% and specificity of 55.1%,suggesting a prediction threshold of 1.550.The AUC of APACHE II score was 0.663 with a sensitivity of 61.3% and specificity of 1.550.The AUC of D-dimer was 0.645,sensitivity was 51.6%,specificity was 75.4%,and critical value was 2061.5.The AUCs of the four combined tests were 0.785,sensitivity was 75.8%,and specificity was 69.6%,and the AUCs of the four combined tests for septic shock were significantly higher than those of RPR and lactate.The AUC of the combined test was significantly higher than that of RPR,lactate and APACHE II scores alone(P<0.05).Conclusions:RPR has a certain predictive value for septic shock and can be used as an important indicator to evaluate the severity of sepsis,but it lacks specificity.The combination of lactic acid,APACHEⅡ score and D-dimer can improve the sensitiv ity and specificity of a single index,and has a higher value in predicting septic shock.