Diagnostic And Prognostic Value Of Injury Severity Score Combined With Procalcitonin And T Lymphocyte Subsets In Post-traumatic Sepsis

Objective:To explore the diagnostic and prognostic value of biomarkers and the injury severity score in post-traumatic sepsis patients,and to determine the diagnostic efficacy of novel combination.Methods: A total of 196 patients with severe trauma were enrolled in this prospective study at the trauma department and the trauma intensive care unit of The First Affiliated Hospital of Xin Jiang Medical University between December2019 and June 2020.Blood was drawn in the first 24 h of admission,testing the levels of biomarkers and the patients’ general information.Patients were divided into the sepsis groupand non-sepsis group according to the diagnostic criteria of sepsis-3.The patients in the sepsis group were then divided into the non-survival group and the survival group according to the prognosis.Logistic regression analysis was used to determine the diagnostic and prognostic factors of post-traumatic sepsis,Receiver operating Characteristic(ROC)curve was performed to compare the diagnostic ability of each biomarker alone and combination of biomakers and scoring for post-traumatic sepsis.Results: There were statistically significant differences in T lymphocyte subsets,PCT,IL-6,lactate and ISS between the sepsis and non-sepsis groups,and between the non-survival and survival groups(P < 0.05).CD4/CD8 and ISS score were the independent influencing factors in the diagnosis of post-traumatic sepsis(P<0.01).PCT,ISS score and CD4/CD8 were selected from different aspects of the pathogenesis of post-traumatic sepsis to form a new combination and the efficacy of their combined diagnosis were tested,The AUC under ROC curve was 0.927,higher than that of PCT,ISS score and CD4/CD8 used alone(0.840,0.866 and 0.847,respectively).And the sensitivity,specificity,negative predictive value and positive predictive value of the combination was also improved compared with the use of those biomarkers and scoring individually(the results of combination were 91.80%,81.48%,94.78% and 67.90%;respectively).The results of Logistic regression analysis on the death of patients with post-traumatic sepsis indicated that the age,T lymphocyte subsets,PCT,lactate and ISS were all related influencing factors for the death of patients with post-traumatic sepsis,among which ISS score was an independent risk factor for the death of patients with post-traumatic sepsis.Conclusion: The combinaion of CD4/CD8,PCT and ISS score is effective in early diagnosis of post-traumatic sepsis;ISS score and CD4/CD8 were independent influencing factors for post-traumatic sepsis.