The Value Of Combined Detection Of Coagulation Indexes And Inflammatory Factors In Judging The Severity And Prognosis Of Sepsis Patients

Objective: To judge the value of coagulation indexes and inflammatory factors in the severity and prognosis of sepsis patients,through combined detection of them in sepsis patients.Methods: 72 patients who were admitted to the emergency ICU of the First Affiliated Hospital of Dalian Medical University from September 2018 to January 2020 and met the diagnostic criteria of sepsis 3.0 were divided into sepsis group and septic shock group based on the severity of infection;Those patients were divided into the no coagulation dysfunction group,the coagulation dysfunction group and the coagulation dysfunction correction group according to whether the patients had coagulation dysfunction(APTT > 60 s or INR > 1.5)and whether the coagulation dysfunction was corrected when it reached the observation endpoint;They were divided into the survival group and the death group on the basis of the 28-day survival.In addition,20 healthy volunteers matched in age and gender were selected as the control group.Peripheral venous blood was collected on the 1st,3rd,7th day after hospitalization,Serum procalcitonin(PCT)was detected by immunochemiluminescence,the concentrations of interleukin(IL)-6 and interleukin(IL)-8 in patients were tested by enzyme linked immunosorbent assay(ELISA).Platelet(PLT)and coagulation function indexes-activated partial thromboplastin time(APTT),prothrombin time(PT),international normalized ratio(INR),D-dimer(D-D)were measured by automatic blood analyzer,and clinical data of platelet,bilirubin,creatinine,blood pressure,urine volume and other clinical data of corresponding time were recorded to calculate and evaluate sequential organ failure score(SOFA)within 24 hours.The survival of the patients within 28 days was recorded.Results: 1.The scores of PCT,IL-6,IL-8,APTT,PT,INR,D-D and SOFA in sepsis patients(sepsis group and septic shock group)on the 1st,3rd and 7th days were significantly higher than those in the control group(all P < 0.05),while PLT was lower than that in the control group(P < 0.05);2.Inflammatory indexes(PCT,IL-6,IL-8)and SOFA scores in coagulation dysfunction group and coagulation dysfunction correction group were significantly higher than those in non-coagulation dysfunction group,with IL-6 and IL-8 statistically different on the 1st,3rd and 7th day(all P < 0.05),significantly different on the 3rd and 7th day(P < 0.001),while PCT was statistically different on the 3rd and 7th day(P < 0.05).The mortality rate of the coagulation dysfunction group was significantly higher than that of the no coagulation dysfunction group and the coagulation dysfunction correction group,with statistical difference(P <0.001);3.The scores of PCT,IL-6,IL-8,APTT,PT,INR,D-D and SOFA in the death group were significantly higher than those in the survival group on the 1st,3rd and 7th day,while the scores of PLT were significantly lower than those in the survival group,with APTT,D-D,PCT,IL-6,IL-8 statistically different on the 1st,3rd and 7th day(all P < 0.05)and PLT,PT,INR statistically different on the 3rd and 7th day(all P < 0.05);4.There were positive correlation among PCT(r=0.416,P < 0.001),IL-6(r=0.611,P <0.001),IL-8(r=0.483,P < 0.001),APTT(r=0.472,P < 0.001),PT(r=0.353,P < 0.05),INR(r=0.423,P < 0.005),D-D(r=0.635,P < 0.001)and the SOFA score,while PLT(r=-0.360,P < 0.05)were negatively correlated with SOFA score.Through analysis of the inflammatory indicators(PCT,il-6,il-8)at day 1,3,and 7 by ROC curve,the predicted AUCs of sepsis patients with coagulation dysfunction was 0.623(95%CI:0.488-0.758,P=0.076),0.687(95%CI:0.558-0.817,P<0.05),0.737(95%CI:0.617-0.856,P<0.05),0.957(95%CI:0.911-1.000,P<0.001),0.949(95%CI:0.904-0.994,P<0.001),0.933(95%CI:0.880-0.985,P<0.001),0.894(95%CI:0.817-0.972,P<0.001),0.936(95%CI:0.883-0.988,P<0.001),0.897(95%CI:0.828-0.966,P < 0.001);5.The ROC curve analysis of coagulation indexes,inflammatory factors and combined detection factors for the prognosis of sepsis patients(P value <0.05)AUC were APTT(AUC = 0.652),DD(AUC = 0.987),PCT(AUC =0.559),IL-6(AUC = 0.721),IL-8(AUC = 0.738),APTT + PCT(AUC = 0.678),APTT+ IL-6(AUC = 0.749),APTT + IL-8(AUC = 0.758),DD + PCT(AUC = 0.989),DD +IL-6(AUC = 0.987),DD + IL-8(AUC = 0.988);Factor Cox regression analysis showed that SOFA score(HR=1.326,95% CI: 1.122-1.566,P=0.001)and coagulation dysfunction(P=0.03)were independent factors affecting the 28-day death risk of sepsis patients.Conclusion:1.Severe inflammatory response and disorder of coagulation system in patients with sepsis.Inflammatory factors and coagulation indexes can reflect the severity and prognosis of the disease to a certain extent,and the value of combined detection factors for the prognosis of sepsis patients is significantly higher than that of single detection index;2.Inflammatory factors such as PCT,IL-6,IL-8 may become biomarkers for early monitoring of coagulopathy in patients with sepsis.This study found that the predictive value of IL-6 on day 1 is the highest;3.The presence of coagulation dysfunction will increase the 28-day mortality rate of sepsis patients,and the SOFA score and coagulation dysfunction are independent factors that affect the 28-day mortality risk of sepsis patients.