The Value Of Combined Detection Of Procalcitonin, D-dimer And Lactic Acid In The Treatment Of Sepsis

Background:Sepsis has developed into an important problem in critical care medicine.sepsis3.0,released in February 2016,is defined as "because of the host response to infection,which can lead to life-threatening organ dysfunction".In recent years,the incidence of sepsis is rising,every year nearly 20 million cases of sepsis.With the continuous development of medical level,the treatment of sepsis has made great progress,but the mortality rate has been high and closely related with hospitalization rates and prolonged hospitalization in the ICU,a serious threat to life and health of patients.Procalcitonin as a infection monitoring indicators is reliable in diagnosis and identification of pathogenic microorganisms in infection and judge the severity of the infection,anti-infection treatment effect and prognosis,etc.,all have important significance.PCT and the severity of the sepsis was significantly positive correlation in Sepsis,can direct response the severity and prognosis of illness development.Although the sensitivity of procalcitonin is relatively high,it is easy to be misdiagnosed due to its low specificity.Clinically,the application of procalcitonin alone to guide the treatment of sepsis is likely to lead to the occurrence of excessive diagnosis and treatment.D-dimer formation and increase reflects the activation of blood coagulation and fibrinolysis system and blood coagulation and fibrinolysis system dysfunction in inflammation and play an important role in the process of development,thus the plasma D-dimer in development and evaluating the condition of patients with sepsis has important guidance value for judging the prognosis.Sepsis occurred,ischemia-reperfusion injury is the most sensitive in intestinal tract,intestinal mucous membrane permeability increased,bacteria and toxins circulation system,thus appeared enterogenous sepsis.However,if d-dimer level is referred to separately,false negative diagnosis may easily occur due to its low sensitivity,making patients miss the best time for treatment.Lactic acid is a product of anaerobic metabolism of cells in the body,which is used to measure the oxygen metabolism and tissue perfusion status of the body.Especially in patients with sepsis and septic shock,imbalance of oxygen supply and oxygen consumption is likely to occur,combined with abnormal tissue perfusion.Therefore,the monitoring of lactic acid in critically ill patients is very necessary.Many patients with sepsis have shock or even multiple organ dysfunction syndrome,so the monitoring of lactic acid is of great significance for the treatment of sepsis.However,considering that lactic acid is not a direct indicator of infection,it is of low guiding value to detect lactic acid alone in sepsis.Therefore,we hope that through the procalcitonin,D-dimer and Lactic acid for joint detection,can further improve the level of that estimate the prognosis of sepsis illness and,reduce the mortality of sepsis patients and improve patient quality of life.Objective: To explore the clinical value of the combined detection of serum PCT,d-dimer and lactic acid in patients with sepsis in judging the patient’s condition and prognosis.Methods: Ninety SEPSIS patients admitted to linyi central hospital from June 2017 to June 2018 were selected as the study subjects.All the diagnoses met the diagnostic criteria of SEPSIS 3.0,that is,infection or suspected infection combined with SOFA score increased by2 on the original basis.There were 58 cases of common sepsis and 32 cases of septic shock.Forty healthy volunteers in the same period were selected as the control group.Exclusion criteria: age <18 years old or >80 years old;Patients with traumatic factors;Patients with tumor or immunodeficiency disease;Patients who have used gamma globulin and glucocorticoid within 1 month;Blood system disease or long-term use of anticoagulant drugs.After the diagnosis of sepsis,venous blood was drawn at 12 h and 24 h respectively to determine the content of procalcitonin,d-dimer and arterial blood to determine the content of lactic acid.The serum procalcitonin and D-dimer in the control group were determined.Methods: procalcitonin(PCT)was detected by immunofluorescence,d-dimer was detected by immunoturbidimetric assay,and lactic acid was detected by colorimetric assay.The differences in the measured values of procalcitonin,d-dimer and lactic acid between the study group and the control group were compared,and their statistical significance was analyzed.According to the survival status of the patients after 28 days in the study group,they were divided into two subgroups,namely,75 cases in the survival group and 15 cases in the death group.At 12 h and 24 h,the differences in the measured values of procalcitonin,d-dimer and lactic acid between the survival group and the death group were compared,and their statistical significance was analyzed.The above three indicators were combined to study whether the combined indicators had advantages in sensitivity,specificity,positive predictive value,negative predictive value and other aspects compared with each single index.Results: There was no significant difference in age,gender and basic condition between the two groups(P>0.05).1.Compared with the control group,the values of procalcitonin,d-dimer and lactic acid in the study group at 12 h and 24 h after the diagnosis of sepsis were significantly higher thanthose in the control group,with statistically significant differences(P<0.05).2.Compared with the survival group,the measured values of procalcitonin,d-dimer and lactic acid in the death group at 12 h and 24 h after the diagnosis of sepsis were significantly higher than those in the survival group,with statistically significant differences(P<0.05).3.The 12-hour data analysis of the diagnosis of sepsis showed that the combined test indexes of procalcitonin,d-dimer and lactic acid,as well as the product term of the three were of high accuracy,but the accuracy of the combined test was better than that of the single index.In addition,the sensitivity and specificity of each single index could not be taken into account,and the combined index was superior to the single index.4.According to the 24-hour data analysis of the diagnosis of sepsis,the detection indexes of procalcitonin,d-dimer,lactic acid and the combined synthesis of the three have strong accuracy,but the accuracy and sensitivity of the combined detection are better than each single index,and the specificity is basically the same as each single index.The combined index has both sensitivity and specificity,and is a better indicator for judgment.5.The data of procalcitonin,d-dimer and lactic acid at 12 h and 24 h were analyzed dynamically,and the accuracy of each index was increased.The accuracy and sensitivity of the combined indicators at 12 h and 24 h were higher than that at 12 h,and the specificity was basically flat.Conclusion: Procalcitonin,d-dimer and lactic acid levels were significantly correlated with sepsis.Combined with clinical conditions,detection of PCT,d-dimer and lactic acid levels can guide clinicians to accurately judge the condition and prognosis of sepsis,which is more advantageous than single indicator monitoring and has important value in the treatment of sepsis.