Study On Inflammatory Makers In Septic Shock Patients With Different Infection Sites

Objective: To observe the levels of inflammatory indicators in patients with septic shock at different infection sites,and to explore the role and clinical value of various inflammatory indicators in the diagnosis of septic shock at different infection sites,so as to provide reference for the clinical diagnosis and treatment of sepsis.Methods: This study was a single-center,retrospective,cohort study of septic shock patients admitted to the emergency ICU of the second hospital of hebei medical university from January 2016 to January 2019.Patients were screened according to inclusion criteria and exclusion criteria.Patients were divided into survival group and death group according to the prognosis in hospital.If there were differences between the two groups,ROC curve analysis was performed.The included subjects were divided into three groups according to the infection site: pulmonary infection group,abdominal infection group,urinary tract infection group,and skin and soft tissue infection group.Collected the clinical data of patients with sepsis shock including gender,age,infection site,etc.,collection of patients in the ICU temperature(T),pulse frequency(P),blood pressure(BP),white blood cell count(WBC),lactic acid(Lac),hypersensitive c-reactive protein(Hs-CRP),calcitonin(PCT),electrolytes,liver function,renal function,APACHE II score and SOFA score,the test results of the above four groups of statistical analysis,discusses different parts of the initial PCT,Hs CRP,WBC,Lac in groups if there is a statistically significant.SPSS21.0 software was used for statistical analysis,and P<0.05 was considered statistically significant.PCT>100ng/ml is calculated as 100ng/ml.Result:1.Basic information of patients: 70 out of 118 patients met the standard.There were 38 men and 32 women.There were 24 cases(34.29%)in the pulmonary infection group,18 cases(25.71%)in the celiac infection group,11 cases(15.71%)in the urinary tract infection group,and 17 cases(24.29%)in the skin and soft tissue infection group.There were no statistically significant differences in age,gender and general admission between the groups(P>0.05).2.Comparison of inflammatory markers between the death group and the survival group: 34 died and 36 survived in 70 cases.Comparison of inflammatory indicators between the death group and the survival group: there was a statistically significant difference in the initial PCT between the death group and the survival group(P<0.05).The initial Lac of the death group and the survival group was significantly different(P<0.05).There was no significant difference in initial WBC between the death group and the survival group(P>0.05).There was no significant difference in initial hs-crp between the death group and the survival group(P>0.05).The initial PCT AUC was 0.805(95%ci was 0.703 ~ 0.906),the difference was statistically significant(P<0.05),and the Cutoff value was 49.43.The sensitivity and specificity to evaluate the prognosis were 78% and 76%,respectively.The initial Lac AUC was 0.786(95%ci was 0.679 ~ 0.893),the difference was statistically significant(P<0.05),the Cutoff value was 3.58,and the sensitivity and specificity to evaluate the prognosis were 89% and 58%,respectively.3.Kruskal-wallis H rank sum test showed that the initial PCT of the lung infection group,the abdominal infection group,the urinary tract infection group and the skin and soft tissue infection group were not all the same,with statistical differences(H=11.5,P=0.009).After using the Bonferroni method to correct the significance level two is found that the initial PCT in the pulmonary infection group and abdominal cavity infection group difference was statistically significant(P = 0.034),pulmonary infection and urinary tract infection group difference was statistically significant(P = 0.033),no statistical difference between the other groups.The median and interquartile spacing were 10.5(89.6),100(65.3),100(50)and 46.0(80.4),respectively,in the lung infection group,the abdominal infection group,the urinary tract infection group and the skin and soft tissue infection group.There was no significant difference in WBC between the groups,and the P value was 0.062.There was no significant difference in Lac between each group,and the P value was 0.817.There was no significant difference in hs-crp among the groups,with a P value of 0.472.Conclusions:1.The initial PCT has a high sensitivity and specificity for the prognosis of patients with septic shock,which has a certain predictive value for the prognosis of patients with septic shock.Initial Lac has a high sensitivity and poor specificity for the prognosis of patients with septic shock,and its predictive value for the prognosis of patients with septic shock is slightly worse than that of the initial PCT2.The initial PCT of sepsis shock patients at different infection sites was different,and the initial PCT of pulmonary infection was significantly different from that of abdominal infection and urinary tract infection.The detection values of abdominal infection and urinary tract infection were higher and the dispersion was smaller.However,the detection value of pulmonary infection is small and the dispersion is large.3.Hs-crp,lactic acid,and white blood cell counts were not different in septic shock at different infection sites.