| BACKGROUND&OBJECTIVE:Burn sepsis is one of the leading causes of death in patients with extensive burns.Early implementation of antibacterial therapy is critical to the improvement of prognosis results,but excessive treatment will increase the retrospective analysis of adverse events,increased microbial resistance,and increased financial burden on patients.Blood culture is the gold standard for diagnosis,but it does not provide a good guiding role in the early stage because it lags behind the development of the disease.In recent years,early detection of biomarkers of the body has important clinical significance for judging sepsis and distinguishing between Gram-negative and Gram-positive bacteria.This study used early PCT,WBC,N%,PLT and general clinical data to identify the association between burn-derived sepsis caused by G~—bacteria and G~+infection in burn patients.Methods:A retrospective analysis of the clinical data of 112 patients with sepsis confirmed by the intensive care unit(BICU)of our hospital from January 1,2014 to December31,2018(collecting PCT values,white blood cell counts)WBC),percentage of neutrophils(N%),and general clinical data,etc.).According to the results of the first blood culture positive results(Gram-negative bacteria group,Gram-positive bacteria group)and clinical outcomes(survival group and death group),the differences of each observation index in each group were compared(P<0.05),Area Under roc Curve(AUC)analysis and evaluation of PCT in the identification of G-bacteria and G+bacteria group,P<0.05 difference statistically significant;PCT,total burn area and III degree burn area to death Comment:Analysis of the estimated ROC curve.Results:(1)The main distribution of bacteria is:G~—bacteria group accounted for 70%,of which the main bacteria are Klebsiella pneumoniae accounted for 28.57%,Acinetobacter baumannii accounted for 24.11%,Enterobacter cloacae accounted for7.14%,and patina The bacterium accounted for 4.46%;the G~+group accounted for30%,of which the main bacteria were 11.60%of Staphylococcus aureus and 9.82%of Staphylococcus epidermidis.(2)Compared with the G~+group,the PCT(procalcitonin)increased significantly in the Gram-negative group,and the difference was statistically significant(t=4.78,P<0.05).The G~—bacteria group had more PLT than the lower limit of the normal value,and the difference was statistically significant compared with the G~+group(?~2=4.36.,P<0.05).In addition,the incidence of inhalation injury was higher in the G~—bacteria group,and the difference was statistically significant(P<0.05).WBC,N%,PLT,two groups of prognosis,burn area,third degree burn area,WBC reduction,blood culture results positive from burn days,presence of inhalation injury,burn properties,post-burn admission time,first operation time,and hospitalization There was no significant difference in time between the two groups(P>0.05).(3)Using the PCT as a test variable in the G~—and G~+groups,the ROC curve for the identification of G~—and G~+infections was constructed,AUC=0.773(95%confidence interval:0.668-0.887),AUC and Zero hypothesis:the difference of real area=0.5 is P<0.05,which is statistically significant.When the cutoff value is 5.235 ng/mL,the Youden index is the largest,0.485,the sensitivity is 89.7%,and the specificity is 58.8%.(4)In the Gram-negative group,the death group was compared with the survival group,32 cases in the death group and 46 cases in the survival group.The mortality rate was 41.03%.The PCT increased significantly in the death group,and the difference was statistically significant(t=7.07,P<0.05);the total burn area and the III degree burn area of the death group were higher than the survival group,the difference was statistically significant(Z=-6.10,t=8.44,P<0.05).In the Gram-positive group,the death group was compared with the survival group,10 patients in the death group and 24 patients in the survival group,the mortality rate was 29.41%;the PCT also increased significantly in the death group,the difference was statistically significant(Z=-3.74,P<0.05).The total burn area and III degree burn area of the death group were higher than the survival group,the difference was statistically significant(Z=-4.28,t=5.02,P<0.05);(5)PCT value,total burn area and III degree Burn area was used as a test variable to construct a ROC curve for the assessment of death.The ROC curves of patients with PCT values,total burn area and III degree burn area are shown in the figure(AUC=0.859,0.922,0.905),AUC and null hypothesis:real area=0.5difference P<0.05,statistically significant,Serum PCT values,total burn area,and III burn area can be considered as the ability to assess the risk of death;(1)The main distribution of bacteria was:G~—bacteria group accounted for 70%,of which the main bacteria were Klebsiella pneumoniae accounted for 28.57%,Acinetobacter baumannii accounted for 24.11%,Enterobacter cloacae accounted for 7.14%,and patina Pseudomonas accounted for 4.46%;G~+bacteria accounted for 30%,of which the main bacteria were 11.60%of Staphylococcus aureus and 9.82%of Staphylococcus epidermidis.(2)Compared with the G~+group,the PCT increased significantly in the Gram-negative group,and the difference was statistically significant(t=4.78,P<0.05).The G~—bacteria group had more PLT than the lower limit of the normal value,and the difference was statistically significant compared with the G~+group(?~2=-1.61,P<0.05).In addition,the proportion of inhalation injury in the G~—bacteria group was higher than that in the G~+group,and the difference was statistically significant(P<0.05).WBC,N%,PLT,two groups of prognosis,burn area,third degree burn area,WBC reduction,blood culture results positive from burn days,presence of inhalation injury,burn properties,post-burn admission time,first operation time,and hospitalization There was no significant difference in time between the two groups(P>0.05).(3)Using the PCT as a test variable in the G~—and G~+groups,the ROC curve for the identification of G~—and G~+infections was constructed,AUC=0.773(95%confidence interval:0.668-0.887),AUC and Zero hypothesis:the difference of real area=0.5 is P<0.05,which is statistically significant.When the cutoff value is5.235 ng/mL,the Youden index is the largest,0.485,the sensitivity is 89.7%,and the specificity is 58.8%.(4)In the G-bacteria group,32 patients in the death group and 46patients in the survival group had a mortality rate of 41.03%.The PCT increased significantly in the death group,and the difference was statistically significant(t=7.07,P<0.05);the total burn area and III degree burn area of the death group were higher than the survival group,the difference was statistically significant(Z=-6.10,t=8.44,P<0.05).In the G+group,the death group was compared with the survival group,10patients in the death group and 24 patients in the survival group,the mortality rate was 29.41%;the PCT was also significantly increased in the death group,the difference was statistically significant(Z=-3.74).P<0.05);the total burn area and III degree burn area of the death group were higher than the survival group,the difference was statistically significant(Z=-4.28,t=5.02,P<0.05);(5)Using the PCT value,total burn area and III degree burn area as test variables,construct the ROC curve of the index for death evaluation.The ROC curves of patients with PCT values,total burn area and III degree burn area are shown in the figure(AUC=0.859,0.922,0.905,),AUC and null hypothesis:real area=0.5 difference P<0.05,statistically significant,Serum PCT values,total burn area,and III burn area can be considered as the ability to assess the risk of death.Conclusions:(1)the serum PCT level of burn patients with g-bacterial sepsis was higher than that of burn patients with G~—bacterial sepsis,and the determination of serum PCT level may be helpful for the empirical selection of antimicrobial therapy.(2)patients with burn sepsis combined with inhalation injury are more likely to be infected by G~—bacteria.(3)PLT reduction rate is higher in G~—bacteria,suggesting that thrombocytopenia is more common in G~—bacteria.(4)serum PCT and PLT can be used as the reference indicators for the prognosis of burn sepsis patients.When the PCT level of patients increases and the PLT level decreases,it indicates poor prognosis of patients. |
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