| Part Ⅰ The diagnostic value of procalcitonin in early postoperative infection after radical cystectomy.Objective:To observe the serum hemodynamics of PCT(Procalcitonin),IL-6(Interleukin-6),CRP(C-Reactive Protein)and WBC(White blood cell)in patients underwent radical cystectomy and urinary diversion,evaluate the absolute value,changes of the absolute value and percentage variation of PCT,CRP,WBC and IL-6 in both the infection and non-infection group,indentify the tissue damage between the open surgery group and laparoscopic surgery group through the value of PCT,CRP,WBC and IL-6.Methods:From May 2015 to May 2017,a total of 238 patients were included in the study who received radical cystectomy and urinary diversion at the Department of Urology,the Second Affiliated Hospital of Kunming Medical University.The time point on which infection was observed was defined as daytO for the infection group,the next day is defined as daytl;the time serum PCT was recorded at the peak was defined as daytl in the non infected group,the previous day was defined as dayt0.The value of the daytl time point is the absolute value,the delta value was calculated as daytl-dayt0,percentage change value was calculated as daytl-dayt0/day t0.T test or Mann-Whitney test was used for the comparison between quantitative data,x2 test and Kruskal-Wallis Test was used to for the comparison between count data and level information.The evaluation of the diagnostic ability of inflammatory markers was based on the receiver operating characteristic curve.Result:42 patients were diagnosed as infection and 196 patients were diagnosed as non-infection.For the Non-infectious cases,laparoscopic assisted surgery was performed in 86 cases and open surgery in 110 cases.Compared to the non-infected group,the infection group experienced longer operation time,more intraoperative blood loss,more opportunities for blood transfusion.The response of IL-6 to operation was the fastest,and the peak was reached 24 hours after the operation.The serum value of PCT and CRP reached the peak on the second days after the operation.Between the infection group and the non-infection group,only the difference between PCT and IL-6 was statistically significant;which is 2.9(1.3,interquartile range)vs 1.4(1.5,interquartile range)ng/ml,p<0.01 and 113.4(167,interquartile range)vs 156.5(277.8,interquartile range)pg/ml,P<0.01.Statistical difference of WBC and the CRP was not significant between the infection group and the non-infection group group.The serum value of PCT,IL-6 and SOFA score were statistical different among patients with different levels of infection,such as control,SIRS,sepsis and septic shock group.The area under the ROC curve of absolute value of PCT for the diagnosis of infection is 0.72(95%CI 0.62-0.8),Conclusion:Serum PCT and IL-6 are the relatively accurate indicators of the diagnosis after radical cystectomy and correlated with the severity of infection.Compared with the absolute value of PCT,CRP,IL-6 and WBC,the changes in dynamic monitoring of the above indica,tors were more accurate in the diagnosis of infection.Associated with the severity of surgical injury of acute phase proteins such as CRP and inflammatory factors such as IL-6 is significantly higher in the open surgery,suggests local trauma to the body is relatively severe.Part Ⅱ The value of Presepsin in the evaluation of treatment and prognosis in the rabbit cecum ligation perforation modelObjective:In the rabbit model of sepsis,to evaluate PCT and IL-6 and Presepsin in the role of sepsis treatment and prognosis,and to assess the correlation of Presepsin,PCT and IL-6。The accuracy of the prognostic prediction of sepsis of PCT,il-6 and Presepsin at different time points was determined by analyzing the values of 8 hours,2 days.By analyzing the blood culture of dead animals,to clear whether bacterial dissemination is the only cause of sepsis death,and further verify the definition of SEPSIS 3 sepsis.Methods:48 rabbits were divided into three groups,group A was induced by cecal ligation and puncture and given imipenem treatment(regular treatment group),group B was induced by cecal ligation and puncture and treated with metronidazole(Improper treatment),group C was sham operation group,only laparotomy,and given imipenem treatment.Blood samples were collected from rabbit ear vein at 6 hours after 8 hours(h8),16 hours(h16),24 hours(h24),2 days(day2),4 days(day4)and 6 days(day6)respectively.The IL-6,PCT and Presepsin values were measured,and blood culture and plate colony count were performed at the same time.Spearman linear correlation analysis was used to analyze the correlation between Presepsin and PCT and IL-6.ROC curve was used to evaluate the predictive value of these indexes to the death outcome of experimental animals at different time points.Result:At the end of the experiment,12 animals in group A survived,all of them died in group B,and 14 survived in group C,while in group A,With the treatment of imipenem,PCT and Presepsin reached peak value 16 hours after the surgery,while B group reached the highest value before the death of experimental animals.The response of IL-6 to treatment was slower than that of PCT and Presepsin,and reached a peak after 24 hours after the operation.The Pearson correlation coefficient of PCT and Presepsin is 0.594,p<0.01,the Pearson correlation coefficient of IL-6 and Presepsin is 0.828,p<0.01 indicates that presepsin has a positive correlation with IL-6 and PCT,and the correlation is good.2 days after the operation,the accuracy of the prediction values of the animal deaths was higher,the area under the curve,PCT,IL-6,and presepsin were 0.85,0.81,and 0.84,respectively.Conclusion:Compared to IL-6,PCT and Presepsin have a shorter reaction time in evaluating the treatment of sepsis,which may be the first choice to evaluate the appropriate or inappropriate antibiotic treatment for sepsis.The level of Presepsin has a good correlation with IL-6 and PCT in laboratory animals.It may become a biochemical marker for diagnosing infection.The higher Presepsin level on the second day after operation can predict the death outcome of septic animals accurately.Bacterial spread is not the only cause of death of sepsis... |
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