Changes And Clinical Significance Of Inflammatory And Immunity Indexes In Burn Patients With Sepsis

Objective:To investigate the levels of procalcitonin（PCT）,hypersensitive C-reactive protein（hs-CRP）,cortisol（COR）,white blood cell count（WBC）,Neutrophil to Lymphocyte Ratio（NLR）,CD₃⁺,CD₄⁺,CD₈⁺in burn patients with sepsis and to analyze their clinical value.Methods:Clinical data of 121 cases of burn patients admitted to The first affilated hospital of chengdu medical college and Mianyang central hospital from August 2017 to December2019 were retrospective analysis,among them,49 patients were accompanied by sepsis（sepsis group）,and 72 patients were not accompanied by sepsis（non-sepsis group）.The patients with sepsis were divided into good prognosis group（n=44）and poor prognosis group（n=5）according to the prognosis.The levels of PCT,hs-CRP,COR,WBC,NLR,CD₃⁺,CD₄⁺,CD₈⁺in all subjects were dynamically measured and compared.The receiver oprerating characterrastics curve（ROC）was used to calculate the apecificity and sensitivity area under the curve（AUC）of PCT、hs-CRP、COR、WBC、NLR、CD₃⁺、CD₄⁺、CD₈⁺for diagnosis of burns with sepsis,to evaluate the diagnostic value for the above eight factors in burn patients with sepsis.Result:1、PCT,hs-CRP,COR,WBC,NLR,CD₈⁺levels in sepsis group were higher than those in non-sepsis group,CD₃⁺,CD₄⁺levels in sepsis group were lower than those in non-sepsis group（P<0.05）2、PCT,hs-CRP,COR,WBC、NLR,CD₈⁺levels in poor prognosis group were higher than those in good prognosis group,CD₃⁺,CD₄⁺levels in poor prognosis group were lower than those in good prognosis group（P<0.05）.3、The AUC,specificity and sensitivity of PCT,hs-crp,COR,WBC,NLR,CD3+,CD4+and CD8+T lymphocytes used to predict and assist in the diagnosis of burn sepsis were as follows:（1）the area under the PCT curve was 0.836,the specificity was 87.5%,and the sensitivity was 63.3%.（2）the area under the hs-crp curve was 0.793,the specificity was 63.9%,and the sensitivity was 85.7%.（3）the area under the COR curve was 0.81,the specificity was 89.9%,and the sensitivity was 49.4%.（4）the area under the WBC curve was 0.69,the specificity was 40.9%,and the sensitivity was 90.8%.（5）the area under the NLR curve was 0.82,the specificity was 86.6%,and the sensitivity was 69.2%.（6）the area under the CD3+curve was 0.814,the specificity was 79.2%,and the sensitivity was 75.5%.（7）the area under the CD4+curve was 0.825,the specificity was 62.5%,and the sensitivity was 89.8%.（8）the area under the CD8+curve was 0.766,the specificity was 70.8%and the sensitivity was 76.6%.Conlusion:1、The levels of PCT,hs-crp,COR,WBC,NLR and CD8+were abnormally increased in burn patients with sepsis,while the levels of CD3+and CD4+were abnormally decreased,which was related to the severity of the disease.The above indicators have certain clinical reference value for the prognosis judgment of burns sepsis.2、Shock phase and humoral reabsorption phase are the first peak of sepsis in burn patients,and excessive inflammatory response and immunosuppression promote the development of sepsis in burn patients.After active supportive treatment,the patients with good prognosis gradually leveled off in about 2 weeks.Therefore,in the shock stage and the humoral reabsorption stage of severe burn patients,it is necessary to closely monitor the vital signs and laboratory indicators,and formulate the corresponding treatment plan,so as to reduce the incidence of burn sepsis.3、The levels of PCT,NLR,CD3+and CD4+T lymphocytes have high clinical efficacy in predicting severe burns with sepsis,which can be applied to the early prediction and clinical diagnosis of burns with sepsis.Monitoring the levels of PCT,NLR,CD3+and CD4+T lymphocytes in severely burned patients can more comprehensively assess the degree of inflammatory response and the status of immune function in vivo.