Study On Prediction Of Septic Shock By Heparin Binding Protein Combined With (Sequential Organ Failure Assessment) SOFA Score

BackgroundsAccording to the latest definition of sepsis 3.0 issued by the Society of Critical Care Medicine(SCCM)in 2016,sepsis is a life-threatening organ dysfunction caused by host reaction disorder caused by infection.Septic shock,there are abnormalities in circulation,cell and metabolic function.The diagnostic criteria are based on sepsis and adequate fluid resuscitation.The use of vasoactive drugs can maintain the mean arterial pressure above 65 mm Hg and blood lactate≥2 mmol/L.Both sepsis and septic shock have a high mortality rate and are one of the major problems faced by critical care.How to accurately assess such patients in the early stage,stratify the disease severity in patients who may have sepsis or have entered the early stage of sepsis or have septic shock,and carry out intervention treatment in the early stage can have a significant impact on clinical results.Conventional methods for the diagnosis of sepsis,mainly focusing on blood culture reports,followed by molecular diagnostic techniques,and current high-tech biosensor diagnostic methods,a large number of biomarkers can help clinicians diagnose at an early stage.Heparin-binding protein(HBP)acts as a granule protein released by neutrophils,induces monocyte/macrophage chemotaxis and activation,vascular leakage and edema formation,leading to dysfunction of vascular barrier and enhancement of cellular inflammatory response leading to organ Dysfunction,mediating the development of sepsis.Foreign studies have shown that plasma HBP can predict the onset of shock in severely infected patients.ObjectiveTo explore the predictive value of heparin-binding protein(HBP)combined with SOFA score in patients with septic shock.Methods 78 patients with sepsis admitted to the Department of Critical Care Medicine(ICU)of Henan Provincial People’s Hospital from December 2016 to May 2017 were selected.30 healthy patients were selected as controls.The patient’s gender,age,length of hospital stay,blood culture results within 24 hours of admission,white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),blood lactate(Lac)and 24 hours after admission were recorded.Heparin-binding protein(HBP),as well as sequential organ failure score(SOFA)and acute physiology and chronic health status scoring system II(APACHEII)within 24 hours of admission;concurrently recorded patient organ failure and vasoactive agents use within 24 hours of admission.The differences between the above indicators in each group were compared,and the receiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of HBP,SOFA score and their combination in patients with septic shock.Results A All patients were included in the final analysis,including 64 in the sepsis group and 14 in the septic shock group.Compared with the sepsis group,the proportion of patients with septic shock who were positive for blood culture,vasoactive agents,and organ failure was higher[57.1%(8/14)vs.7.8%(5/64),100.0%(14/14).)than 65.6%(42/64),100.0%(14/14)vs.18.8%(12/64),both P<0.01],SOFA and APACHE Ⅱ scores are also higher[SOFA(minutes):8.93±4.16 ratio)5.89±2.68,APACHEⅡ(minutes):22.29±4.89 vs 15.28±5.14,both P<0.05];however,there was no significant difference in gender,age and ICU stay time between the two groups.Compared with the healthy control group,HBP,PCT,CRP and Lac were significantly increased in the sepsis group and the septic shock group;the HBP in the septic shock group was significantly higher than that in the sepsis group(μg/L:120.33±43.49 vs 68.95±54.15,P<0.05),but there was no significant difference in PCT,CRP and Lac between septic shock group and sepsis group[PCT(ng/ml):1.42(0.47-46.00)vs 0.71(0.19-4.5),CRP(mg/1):102.90±78.12 vs 102.07±72.15,Lac(mmol/l):1.81(1.14-3.65)vs 1.59(1.17-2.24),both P>0.05].ROC curve analysis showed that the SOFA score predicted the area under the ROC curve(AUC)of septic shock was 0.715[95%confidence interval(95%CI)=0.540-0.890,P=0.012],and the optimal diagnostic cutoff value was 7.5.Time-sharing,sensitivity was 64.3%,specificity was 76.6%;HBP had an AUC of 0.814(95%CI=0.714-0.913,P<0.001),and the best diagnostic cutoff value was 89.43 μg/L,the sensitivity was 78.6.%,specificity was 76.6%;when the two were combined,the AUC was 0.829(95%CI=0.724-0.935,P<0.001),the sensitivity was 92.9%,and the specificity was 61.9%.Conclusion HBP can be used as a biological indicator for predicting septic shock,and combined with SOFA score can improve the accuracy of predicting septic shock.