The Relationship Between Serum Oxidative Stress Status And Prognosis In The Patients With Sepsis

Objective:To observe the relationship between oxidative stress status and prognosis in the patients with sepsis,and to investigate the influence of oxidative stress status to the prognosis.Methods:The 45 patients who were divided into sepsis group and non-sepsis group, were studied after they were admitted to emergency observation room and ICU of Tianjin Medical University General hospital from August 2007 to December 2007. The 32 patients with sepsis who met sepsis criteria according to 2001 SCCM/ESICM/ACCP/AIS/SIS International Sepsis Definition Conference were selected as sepsis group,other 13 patients were selected as non-sepsis group.Patients who used antioxidant in recent three months were excluded.We collected clinical variables of all patients after they were hospitalized within 24 hours,and calculated APACHEⅡscore.At the same time,in order to explore the oxidative stress status of patients,serum malondialdehyde(MDA)and total antioxidative capacity(T-AOC) were also measured in the first day.Based on a Single factor logistic regression analysis to define the risk factors,we performed the multinomial logistic regression analysis and found independent risk factors which had important effect on clinical. We divided the 32 patients with sepsis into non-survival group and survival group, according to the prognosis,and compare the clinical variable difference between the two groups.We also used receiver-operating-characteristic curve(ROC)analysis in serum MDA and APACHEⅡscore for prognosis in the patients with sepsis.Results:There are negative correlation between the serum MDA and T-AOC both in sepsis group(r=-0.902)and non-sepsis group(r=-0.793).Between sepsis group and non-sepsis group,there are significant difference in serum MDA(sepsis group 9.52±1.69nmol/mL,non-sepsis group 7.48±0.71nmol/mL,p＜0.01),and T-AOC(sepsis group 9.79±1.72U/mL,non-sepsis group 14.05±1.81U/mL,p＜0.01).We performed the bivariate correlations analysis between serum MDA and clinical variables which reflect the severity of sepsis,and found that there are positive correlation between serum MDA and APACHEⅡscore(r=0.844),the numbers of dysfunctional organ(r=0.717),C reactive protein(r=0.663),oxygenation index(r=-0.409).There are also significant difference in serum MDA(non-survival group11.36±1.44nmol/mL,survival group 8.91±1.29nmol/mL,p＜0.01),and T-AOC(non-survival group 7.86±1.38U/mL,survival group 10.44±1.29U/mL,p＜0.01)between non-survival group and survival group of patients with sepsis.After performing the multinomial logistic regression analysis,we found that serum MDA is a independent risk factors for prognosis in the patients with sepsis.The area under ROC curve for serum MDA was 0.888±0.061,for the APACHEⅡscore was 0.891±0.057.Conclusions:1.In the patients with sepsis,serum MDA is increased,and serum T-AOC is decreased.Septic patients exist severe oxidative stress.2.The serum MDA level can reflect the severity of sepsis.The higher level of serum MDA,the more severe sepsis.3.According to the serum MDA level,we can predict the prognosis of the patients with sepsis effectively.The high serum MDA level is a predictor of poor prognosis in the septic patients.