| Objective: We observed the items,such as procalcitonin(PCT)and the changes of neutrophil CD64,the percentage of T lymphocyte subsets,SOFA score and APACHE II score,to assess the severity and prognosis in patients with sepsis.Methods: The patients were all the in-patients from Xingtai people's Hospital(2015.6-2016.6)and It was total 72 patients with sepsis.Then the patients divided into the Sepsis group and the Septic Shock group(According to the 2016 International Sepsis standard guidelines).At first days and seventh days after admission,each patients were measured of the PCT,neutrophil percentage of CD64 and T lymphocyte subsets and other routine items and calculated the APACHE II score and SOFA score of patients.According to the outcome of followed up for 28 days,the patients divided into survival group and death group,then analysis of the relationship between observation index and sepsis.Application SPSS 23.0 software package for data processing,the normal distribution of quantitative data(x ± s),the non-normal distribution of the data using the median(quartile range)that the group were compared using t test or rank sum test,count data using ?2 test.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.Meaningful indicators to draw the receiver operating characteristic curve(ROC curves)were calculated area under ROC curve of various indicators,to compare the sensitivity and specificity of the prognosis.Two variables associated with linear correlation analysis,relevance application of Pearson's correlation coefficient analysis.P<0.05 was considered statistically significant.Results:1 It was 72 cases of sepsis patients in our study,of which 37 male and 35 female,ages range from 23 to 88,the average age was(59.42±19.70).It was32 cases of pulmonary infection,21 cases of urinary tract infection,and Soft tissue infection in 7 cases,abdominal infection in 3 cases,other parts of the infection in 9 cases.2 According to the 2016 International Sepsis standard guidelines,the patients were divided into Sepsis group and Septic Shock group.Sepsis group were 46 cases,of which 27 male and 19 female,ages range from 23 to 86,the average age was(55.33±21.47);Septic Shock patients were 26 cases,of which 15 male and 11 female,ages range from 45 to 88,the average age was(66.65±13.67).3 According to the outcome of followed up for 28 days,the patients divided into survival group and death group,the total mortality was 31.9%.Death group patients were 23 cases,of which 14 male and 9 female,ages range from 45 to 87,the average age was(64.62+19.40);Survival group patients were 49 cases,of which 26 male and 23 female,ages range from 23 to 86,the average age was(54.32 + 21.26).The mortality were significant differences between the Sepsis group(19.57%)and Septic Shock group(n=53.85%)(?2=5.54,P=0.019<0.05).4 Compared the observation items within 24 hours in Sepsis group and Septic Shock group,find out the items of Septic Shock group,such as serum PCT,the neutrophil percentage of CD64,APACHE score,SOFA score were higher than Sepsis group(P<0.05),but the ratio of T lymphocyte CD4+/CD8+were lower than Sepsis group(P < 0.05).They were Serum PCT 5.23(4.56,8.61)vs1.37(0.53,2.16),neutrophil CD64(%)49.67(32.65,72.31)vs27.38(19.55,43.39),APACHE score 18.22(11,25)vs11.93(6,17),SOFA score of 8(7,9)vs 5(4,7)and the ratio of T lymphocyte CD4+/CD8+ 0.59(0.29,0.91)vs0.92(0.68,1.13),respectively.5 Compared the observation items in 7th day in survival group and death group,find out the items of death group,such as such as serum PCT,theneutrophil percentage of CD64,APACHE score,SOFA score were higher than survival group(P<0.05),but the ratio of T lymphocyte CD4+/CD8+ were lower than survival group(P<0.05).They were Serum PCT 8.23(4.60,11.16)vs1.12(0.61,2.61),neutrophil CD64(%)48.37(39.55,62.39)vs29.67(18.65,32.31),APACHE score 19.67(11,26)vs 12(7,15),SOFA score of 10(8,11)vs5(3,7)and the ratio of T lymphocyte CD4+/CD8+(0.24,0.63 0.32)vs0.83(0.43,1.21),respectively.6 Correlation analysis between APACHE score and other items in different times showed that serum PCT and APACHE score were positively correlated(r = 0.702,0.637,P<0.01),the ratio of T lymphocyte CD4+/CD8+and APACHE score were negative correlation(r =-0.691,-0.659,P<0.01),neutrophil CD64(%)were positively correlated(r = 0.676,0.622,P<0.01)and SOFA score and APACHE score were positively correlated(r=0.663,0.762,P<0.01).7 Based on a single factor logistic regression analysis and performed the multinomial logistic regression analysis,we found that the serum PCT,the ratio of T lymphocyte CD4+/CD8+,neutrophil CD64(%),APACHE II score and SOFA score were independent risk factors which had important effect on the prognosis of sepsis patients,each items can independently evaluated the prognosis of sepsis patients(P<0.05).8 Meaningful indicators,such as the serum PCT,the ratio of T lymphocyte CD4+/CD8+,neutrophil CD64(%),APACHE II score and SOFA score,to draw the receiver operating characteristic curve(ROC curves)to compare the sensitivity and specificity of the prognosis,they were 0.827(95%CI: 0.794 ~ 0.854),0.889(95%CI: 0.867 ~ 0.963),0.901(95%CI: 0.889~0.912),0.914(95%CI: 0.903 ~ 0.926),0.902(95%CI: 0.892 ~ 0.913)respectively,and the optimal critical value were 1.86ng/ml,0.68,57.43%,8.46 points,5.34 points.Using Z test to compare the AUC of each items showed no significant difference(Z=0.202,P>0.05),It means that the serum PCT,the ratio of T lymphocyte CD4+/CD8+,neutrophil CD64(%),APACHE II score and SOFA score have the same evaluation ability to the prognosis.9 Combined three items,Serum PCT with the ratio of T lymphocyte CD4+/CD8+ and neutrophil CD64(%),to assess prognosis,the AUC of the ROC curve was 0.963(95%CI:0.949 ~ 0.976);Combined three items and APACHE II score to assess prognosis,the AUC of the ROC curve was 0.972(95%CI:0.954 ~ 0.981);Combined three items and SOFA score to assess prognosis,the AUC of the ROC curve was 0.976(95%CI:0.959 ~ 0.984);Combined all the five observation items to assess prognosis,the AUC of the ROC curve was 0.986(95%CI:0.962 ~ 0.995).Using Z test to compare the AUC of combination and single items showed significant difference in each group(Z=2.162,P < 0.05);Using Z test to compare the AUC of each combination group showed no significant difference(Z=0.193,P<0.05).The result indicated that combination group than single items has higher sensitivity and specificity on assess prognosis.Moreover,the more items joint,the higher sensitivity and specificity,so it can be combined with these five indicators to assess the prognosis of patients with sepsis.Conclusion:1 The serum PCT,the ratio of T lymphocyte CD4+/CD8+,neutrophil CD64(%),APACHE II score and SOFA score can be used assess the condition and mortality risk of sepsis patients,of which the serum PCT,eutrophil CD64(%),APACHE II score and SOFA score were positively correlated with the severity of the disease and the ratio of T lymphocyte CD4+/CD8+ was negatively correlated with the severity of the disease.2 Combined the serum PCT,the ratio of T lymphocyte CD4+/CD8+,neutrophil CD64(%),APACHE II score and SOFA score has higher sensitivity and specificity to assess the prognosis of patients with sepsis. |
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