Arterial Blood Lactate Clearance Combined With APACHE ? Score Or Procalcitonin For The Prognosis Of Patients With Sepsis

Objective:The purpose of this study was to investigate the value of arterial blood Lactate Clearance Rate(LCR)combined with Acute Physiology and Chronic Health Evaluation?score(APACHE ?score)or procalcitonin(PCT)for the prognosis of patients with sepsis.Methods:This study was a prospective study,which collected 36 patients with sepsis treated in the Department of Respiratory and Critical Care Medicine,Shanxi Medical University First Hospital from September 2017 to December 2019.According to the 28-day survival of patients,they were divided into survival group and death group.Arterial blood was continuously collected for blood gas analysis.The lactate(Lac)levels were recorded at admission,24 hours(24h),and 48 hours(24h)after admission,and the 24 h and 48 h arterial blood lactate clearance were calculated.Meanwhile,recorded the PCT at admission,and the APACHE ? scores within 24 hours and 24 to 48 hours(24h APACHE ? and 24~48h APACHE ?)were calculated according to the worst values of various indexes within 24 hours and 24 to 48 hours after admission.The receiver operating characteristic(ROC)curve was established and the area under the curve(AUC)was calculated to analyze the value of Lac,24 h LCR,48 h LCR,admission PCT,24 h APACHE ? score,24~48h APACHE ? score for the prognosis of sepsis patients.The value of 24 h LCR combined admission PCT,24 h LCR combined 24 hAPACHE ?scoreand 48 h LCR combined 24~48h APACHE ? score for the prognosis of sepsis patients were also analyzed.Results:There were 36 patients with sepsis,18 in the 28-day survival group and 18 in the death group.The 24 hLCR and 48 h LCR were higher in the survival group than in the death group.The 24 h APACHE ?score and 24~48h APACHE ? scores were significantly lower than those in the death group,and the difference was statistically significant(P<0.05).In terms of judging the prognosis of the disease,the AUC values of24 hLCR and 48 hLCR are 0.738(95% CI 0.565~0.870)?0.698(95% CI 0.522~0.837);The AUC values of 24 h APACHE ? and 24~48h APACHE ? are 0.767(95% CI0.597~0.891)?0.812(95% CI 0.647~0.922).Compared with the 24 hLCR,48h LCR,and24 h APACHE ? score,the value of 24~48h APACHE ? score is better.The AUC values of 24 h LCR combined admission PCT,24 h LCR combined with 24 h APACHE ?score and 48 h LCR combined with 24~48h APACHE ? score were 0.750(95% CI0.578~0.879),0.827(95% CI 0.665~0.932),0.846(95% CI 0.686 ~ 0.944).The combination LCR and APACHE ? score or PCT has a judgment value on the prognosis of patients with sepsis(P < 0.05),and is higher than the judgment value of a single indicator.Conclusion:LCR combined with APACHE ? score or PCT are more valuable for the prognosis of patients with sepsis than single indicator or score,which can be used as predictors of prognosis in patients with sepsis.