The Research Of Relationship Between Sepsis Prognosis And The Monitor Of Procalcitonin、C-Reactive Protein、Lactate、Acute Physiology And Chronic Health Evaluation Ⅱ Score、Sequential Organ Failure Assessment Score In Early Stage Of Sepsis

【Background】 Both of the morbidity and mortality of patients with sepsis are very high,but the exact pathogenesis of sepsis has not yet been fully understood. Now,C-reactive protein(CRP), procalcitonin(PCT), arterial lactate level or lactate clearance rate、acute physiology and chronic health evaluation(APACHEⅡ)score and sequential organ failure assessment(SOFA)score and other indicators have been used in clinical to evaluate the condition,treatment and prognosis of patients with sepsis.【Objective】 To investigate the changing rules and corresponding relationships of serum CRP、 PCT、arterial lactate level and APACHEⅡ、SOFA score in different layered patients with sepsis in early stage. The relationship between the expression of sepsis and the severity and prognosis of the disease. To evaluate the severity and prognosis of sepsis.【Methods】 Eighty-two patients admitted to ICU of the First Affiliated Hospital of Zhengzhou University from September 2012 to June 2013 periods were observed,included sepsis 30 cases、severe sepsis 28 cases、septic shock 24 cases;and 25 non-sepsis patients in the same period as contrast. Vital signs(including body temperature, respiratory rate, pulse rate, systolic blood pressure, diastolic blood pressure), blood routine examination, liver and kidney function, blood coagulation function, arterial blood gas and lactate was recorded on sepsis onset day(T0),sepsis early stage 1st day(T1)、3rd day(T3)、5th day(T5)、7th day(T7),and APACHE Ⅱand SOFA score of patients were calculated according the worst value of those days. And drawn vein, using double-antibody sandwich ELISA method,solid-phase quantitative immunochromatography to detect PCT; using quantitative immunization rate turbidimetry to detect CRP. Statistical analysis the regular pattern and the relative relationship.Tracking 28 th mortality rate of sepsis patients,according to the death situation,divided the patients to dead group and survival group,analyzing these indexes how to change. Drawing the receiver operator characteristic(ROC) curve and analyzing CRP、 PCT、 lactate level、APACHEⅡand SOFA score’s diagnosing function.【Results】 The CRP、 PCT、lactate level、 APACHEⅡand SOFA score of the sepsis group were higher than the non-sepsis group. Followed sepsis’ s degree deepening,The CRP、PCT、lactate level、 APACHEⅡand SOFA score increased. Septic shock group was higher than severe sepsis group, severe sepsis group was higher than sepsis group(P<0.05 or P<0.01),except CRP in septic shock group was not singnificant higher than severe sepsis group.The 5th、7th ′s level of CRP 、PCT、lactate level 、APACHEⅡand SOFA score of dead group were significant higher than survival group. PCT、lactate level were positive correlated with APACHEⅡand SOFA score, the spearman correlation coefficients(r) were 0.635,0.758; 0.326,0.368(P<0.05 or P<0.01),but CRP was not positive correlated with APACHEⅡand SOFA score. The ROC area under the curve of CRP of patients with Sepsis was 0.750 [95% CI(0.653-0.946),P<0.001]; The ROC area under the curve of PCT of patients with Sepsis was 0.928 [95% CI(0.870-1.000),P<0.001];The ROC area under the curve of blood lactate of patients with Sepsis was 0.742 [95%CI(0.651-0.894),P=0.003];The ROC area under the curve of APACHEⅡscore of patients with Sepsis was 0.912 [95%CI(0.846-0.974),P<0.001];The ROC area under the curve of SOFA score of patients with Sepsis was 0.662 [95% CI(0.543-0.862),P=0.005]; The area under the curve(AUC) of PCT、APACHEⅡscore were singnificant more than CRP 、arterial lactate level and SOFA score’,P<0.05.【Conclusions】 The CRP、PCT、arterial lactate level、 APACHEⅡand SOFA score can be used for severity and prognosis of the patients with sepsis.The level of serum PCT and Lactate are obviously positive correlated with APACHEⅡand SOFA score.The value of PCT、APACHEⅡscore were higher than CRP 、arterial lactate level and SOFA score in the diagnosis of sepsis,dynamic monitoring of the serun procalcitionin level and APACHEⅡscore are valuable in severity classification and prognosis assessment for critically sepsis patients.