Evaluation Of Serum Procalcitonin And Its Dynamic Changes On The Severity And Prognosis Of Sepsis

Objective:The purpose of this study was to explore the value of serum procalcitonin（PCT）and its dynamic changes in evaluating the severity and prognosis of sepsis.Methods:This study is a single center and retrospective study.The clinical data of 135 adult patients with sepsis treated in the intensive care unit of Shanxi Provincial People’s Hospital from May 2020 to February 2022 were collected and analyzed.According to the sepsis 3.0diagnostic criteria,the patients were divided into sepsis group（n=70）and septic shock group（n=70）,and then divided the 135 adult patients into death group（n=42）and survival group（n=93）according to the outcome 28-days after admission.Recording all relevant clinical and laboratory data of patients and comparing the differences of each index between the different groups.By using SPSS 26.0 software,binary logistic regression was used to screen the risk factors affecting the severity of sepsis and death,and the receiver operating characteristic curve was used to analyze the evaluation value of PCT andΔPCT in the severity and prognosis of sepsis.The difference in P<0.05 is statistically significant.Results:A total of 135 patients were included,including 88 males and 47 females.The median age was 67（56,75）years.The overall mortality was 31.1%.Comparing the relevant data of sepsis group and septic shock group,the MAP[78.67（66.5,95.5）mm Hg]in septic shock group was lower than that in sepsis group.The PCT₁[12.14（1.50,58.32）ng/m L],PCT₂[9.47（1.09,48.38）ng/m L],Scr[121.85（79.04,218.30）μmol/L],Lac[2.49（1.65,3.68）mmol/L],CRP[184.21（92.49,254.82）mg/L]and APACHE II[24（19,31.5）]in septic shock group were higher than those in sepsis group;The proportion of patients with renal replacement therapy[16（24.6%）]and cardiopulmonary resuscitation[18（27.7%）]in septic shock group was higher than that in sepsis group,and the28-day mortality（52.3%）was also higher;The site of primary infection in sepsis group was more located in respiratory tract（44.3%）,while in septic shock group,it was more located in abdominal cavity（41.5%）.The difference was statistically significant（P<0.05）.Multivariate logistic regression analysis showed that PCT₂（OR:1.054,95%CI:1.004～1.106,P=0.033）and Lac（OR:1.472,95%CI:1.036～2.091,P=0.031）were the risk factors affecting the severity of sepsis.ROC curve analysis showed that there was little difference between PCT₂[AUC:0.784（95%CI:0.708～0.860）,critical value:4.89（ng/m L）,sensitivity:60.0%,specificity:87.1%]and Lac[AUC:0.768（95%CI:0.688～0.847）,critical value:1.85mmol/L,sensitivity:72.3%,specificity:72.9%]in the evaluation of sepsis severity,and the evaluation efficiency was higher after the combination of the two indexes[AUC:0.821（95%CI:0.750～0.891）,critical value:0.39,sensitivity:72.3%,specificity:78.6%].Comparing the data of death group and survival group shows that:PCT₂[7.17（0.61,50.47）ng/m L],ΔPCT[-0.04（-2.06,16.35）ng/m L],Scr[114.65（72.35,212.73）μmol/L],Lac[2.35（1.6,3.94）mmol/L]and APACHE II[24（19.75,32.25）]in the death group were higher than those in the survival group.The proportion of patients using cardiopulmonary resuscitation[19（45.2%）],renal replacement therapy[12（28.6%）]and mechanical ventilation[31（73.8%）]in the death group was higher than those in the survival group.The difference was statistically significant（P<0.05）.Multivariate logistic regression analysis showed thatΔPCT（OR:1.045,95%CI:1.011～1.082,P=0.01）and APACHE II（OR:1.065,95%CI:1.004～1.130,P=0.036）were the factors to evaluate the survival of 28-days of sepsis.ROC curve analysis showed that the prognostic value ofΔPCT[AUC:0.671（95%CI:0.565～0.777）,critical value:0.98ng/ml,sensitivity:38.1%,specificity:94.6%]was lower than APACHE II[AUC:0.702（95%CI:0.603～0.800）,critical value:27.5,sensitivity:42.9%,specificity:88.2%],and the combined prediction effect[AUC:0.735（95%CI:0.644～0.827）,critical value:0.279,sensitivity:78.6%,specificity:55.9%]ofΔPCT and APACHE II score was better.Conclusion:PCT₂ can be used as an index to evaluate the severity of sepsis.PCT₂ combined with Lac at admission is more valuable to evaluate the severity of sepsis.ΔPCT is not effective in predicting 28-day mortality in patients with sepsis,butΔPCT combined with APACHE II can improve the prognostic value of APACHE II in patients with sepsis.