| Objective In this experiment,by measuring the interleukin 1 receptor type II(IL-1R2),procalcitonin(PCT),tumor necrosis factor-alpha(TNF-alpha),and interleukin 1 beta(il-1 beta),and recording the acute physiology and chronic health evaluation ?(APACHE ?)score and sequential organ failure score(SOFA),used to assess the value of these markers in the severity and prognosis of sepsisMethods This study used a prospective study of patients diagnosed with an infection in the Emergency Intensive Care Unit(EICU)of the First Affiliated Hospital of Dalian Medical University from September 2017 to January 2019,according to sepsis 3.0.The subjects were divided into the sepsis group and the non-sepsis group.Then,25 healthy volunteers from the First Affiliated Hospital of Dalian Medical University were selected as the normal control group.Changes in the serum IL-1R2,PCT,TNF-?,IL-1?,APACHE ? score,and SOFA score were monitored on day 1,day 3,and day 7 in patients in the sepsis and non-sepsis groups.The normal control group monitored the above markers on the day,compared the changes of the above markers and scores in the three groups of patients,evaluated the efficacy of the above markers on the early diagnosis of sepsis.The correlation between the serum IL-1R2 and PCT,TNF-?,IL-1?,APACHE ? score and SOFA score was analyzed by Pearson rank test,and the scatter plot was drawn.According to the 28-day prognosis,sepsis patients were divided into death group and survival group,and the changes of serum IL-1R2,PCT,TNF-?,IL-1?,APACHE ? score and SOFA score were compared between the two groups.The receiver operator characteristic curve(ROC curve)was drawn and the area under the curve(AUC)was calculated,to assess the prognostic value of serum IL-1R2 and other markers and scoring systems in patients with sepsis.The binary logistic regression method was used to calculate the joint measurement value of the joint measurement markers,and its prognostic value was evaluated.Results The serum IL-1R2 concentrations in the sepsis group and the non-sepsis group were significantly higher than those in the control group(P<0.05).The sepsis group was higher than the non-sepsis group,and the difference was statistically significant(P<0.05).Compared with the non-sepsis group,the serum IL-1R2 in the sepsis group and the non-sepsis group was lower than that in the non-sepsis group(P>0.05).The serum IL-1R2 concentration in the survival group and the death group was higher than that in the survival group,but there was no significant difference between the two groups(P>0.05),and it showed a downward trend with the progression of the disease.Serum PCT concentrations in the sepsis group and the non-sepsis group were significantly higher than those in the control group during the same observation period(P<0.05).Compared with the non-sepsis group,the serum PCT concentration in the sepsis group was significantly increased(P<0.01).Compared with the survival group,the serum PCT concentration on the first day of the death group was lower than that in the survival group,and the serum PCT concentration on the seventh day was higher than that in the survival group,and the two were statistically different(P<0.05).The survival group gradually decreased with the progress of the disease,and the death group showed an increasing trend.The APACHE ? score and SOFA score in the sepsis group and the non-sepsis group were significantly higher than those in the control group(P(0.05).The APACHE ? score in the sepsis group was higher than that in the non-sepsis group on day 1(P<0.05).The SOFA scores on days 1 and 3 of the sepsis group were higher than those in the non-sepsis group(P<0.05).Compared with the survival group,the death group had higher APACHE ? score and SOFA score,and increased with the progression of the disease.There was a statistically significant difference in SOFA scores between the two groups on days 1 and 7(P<0.05).There was a statistically significant difference in APACHE ? scores between the two groups on day 7(P<0.05).On the first day of admission,the serum levels of TNF-a and IL-lp in the sepsis group and the non-sepsis group were significantly higher than those in the control group(P<0.05).The sepsis group was higher than the non-sepsis group,and the difference was statistically significant(P<0.05).Compared with the survival group,serum TNF-? was increased in the death group,and serum TNF-a was significantly different on the 7th day(P<0.05).Serum IL-1? in the death group was higher than that in the survival group,and the difference was not statistically significant(P>0.05).As the disease progressed,serum TNF-? and IL-1? showed a downward trend in the two groups.In the early diagnosis of serum IL-1R2,the AUC value of serum IL-1R2 is 0.700,but the P value is 0.097>0.05,which may not be meaningful for early diagnosis.The AUC value of APACHE ? score is 0.726,P value is 0.061>0.05,may not be meaningful for diagnosis.Serum PCT,SOFA score,TNF-?,IL-1? significantly increased the predictive power of early diagnosis of sepsis,AUC value>0.8,P value<0.01,among which serum PCT had the highest diagnostic efficiency.The AUC value at the cutoff value of 1.003 ng/ml was 0.964,the specificity was 100%,and the sensitivity was 86.1%.Serum IL-1R2 was significantly positively correlated with PCT on days 3 and 7,and the difference was statistically significant(P<0.01).There was a significant positive correlation with TNF-a,SOFA score and APACHE ? score in the same period,which was statistically significant(P<0.01).There was a correlation with IL-1? on day 1(P<0.05),but no correlation with comparisons during other observation periods.Serum IL-1R2 on days 1,3 and 7 of sepsis patients did not find significant value in the prognosis evaluation of sepsis 28d,with AUC values less than 0.7 and P values greater than 0.05.On the 7th day,the AUC values of serum PCT,TNF-?,APACHE ? score and SOFA score were all greater than 0.7.They were 0.714,0.743,0.743,and 0.786,respectively,and the P values were all less than 0.05.Among them,the SOFA score is the highest,and when the cutoff value is 5,the sensitivity is 100%,the specificity is 60%,and the prognosis value is the highest.When the SOFA score was combined with the serum IL-1R2 line,the joint test marker was significantly increased,and the AUC value was 0.886,which was significantly higher than the predictive power of the independent marker.Conclusion Serum IL-1R2 is significantly elevated in the early stage of sepsis,but the early diagnosis is not high.Serum IL-1R2 can be used as an effective indicator to assess the severity of sepsis,and the higher the concentration,the more severe the condition may be,and the worse the prognosis may be.Serum IL-1R2 has a small independent evaluation value for the prognosis of sepsis on 28 days.Combined with SOFA score and APACHE ? score,the predictive efficacy is significantly increased,or it can be used as an auxiliary marker for prognosis evaluation of sepsis. |
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