| Research backgroundSepsis is a disorder of the body’s response to infection that leads to life-threatening organ dysfunction.It is the second leading cause of death in ICU patients,which second only to cardiovascular disease.Urosepsis refers to sepsis caused by infection of the urinary system or male reproductive tract,accounting for about 9%to 31%of the total cases of sepsis,with a high risk of death and huge treatment costs.The blood and urine bacterial culture are still,as far as we can see,gold standard for diagnosing sepsis.Nevertheless,the culture cycle is long that takes several days to get the results,and is affected by a variety of factors.In this study,patients with urinary tract infection were selected as research objects,and then divided into sepsis group and non-sepsis group according to whether they developed into sepsis.Clinical data of patients in the two groups were compared in order to find indicators for early prediction,early prediction and timely intervention of patients with urinary tract infection who may develop into sepsis.Research materials and methodsA total of 127 patients with urinary tract infection admitted to our hospital from January 1,2016 to December 31,2022 were selected as the research objects.According to whether they progressed to urosepsis,they were divided into sepsis group and non-sepsis group,including 65 cases in sepsis group and 62 cases in non-sepsis group.To compare the gender,age,history of diabetes,history of hypertension,history of urinary tract stone surgery and results of midstream urine culture between the two groups.To compare the white blood cell count(WBC),neutrophil count(NEUT),percentage of neutrophil count(NEUT%),lymphocyte count(LY),percentage of lymphocyte count(LY%),platelet count(PLT),Serum creatinine(Scr),total bilirubin(TBIL),procalcitonin(PCT)and urinary white blood cell count(U-WBC)between the two groups.In order to look for most valuable early predictor of clinical application.Research results1.Single factor analysis results.The results of single factor analysis showed that there were statistically significant differences in white blood cell count,neutrophil count,percentage of neutrophil count,lymphocyte count,percentage of lymphocyte count,platelet count,and procalcitonin(P<0.05).2.Binary logistic regression analysis results.(1)Increased WBC increased the risk of urosepsis(OR=1.358,95%CI 1.196-1.543,P<0.001).(2)Decreased PLT increased the risk of urosepsis(OR=0.984,95%CI 0.975-0.992,P<0.001).(3)Elevated PCT increased the risk of urosepsis(OR=1.054,95%CI 1.015-1.096,P=0.007).3.ROC curve analysis.(1)The area under the curve(AUC)of WBC was0.828(95%CI 0.751-0.889,P<0.001),the maximum Youden index was 0.594,the optimal critical value was 14.52×10~9/L,the sensitivity was 72.3%,and the specificity was 87.1%.(2)The area under the curve(AUC)of PLT curve was0.775(95%CI 6693-0.845,P<0.001),the maximum Youden index was 0.415,the optimal critical value was 205.0×10~9/L,the sensitivity was 75.4%,and the specificity was 66.1%.(3)The area under the curve(AUC)of PCT was0.803(95%CI 0.723-0.868,P<0.001),the maximum Youden index was 0.523,the optimal critical value was 3.093 ng/ml,the sensitivity was 86.2%,and the specificity was 66.1%.(4)The area under the curve(AUC)of combined detection of WBC and PCT was 0.887(95%CI 0.819-0.937,P<0.001),the maximum Youden index was 0.714,the sensitivity was 90.8%,and the specificity was 80.7%.(5)The combined detection of WBC and PCT was compared with the area under the curve of WBC and PCT alone,and the results showed that there were statistically significant differences(Z=2.359,2.224,P=0.018,0.026).Research conclusionThe combined detection of WBC and PCT has a good application value in the early prediction of urosepsis progression from urinary tract infection,which is superior to single detection of WBC and PCT.In the face of urinary tract infection in clinical practice,it can be combined with the optimal threshold value of WBC and PCT,early prediction of the occurrence of urosepsis,early intervention,reduce the cost of treatment,improve the curative effect. |
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