| Objective:This article aims to explore the interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)and neutrophil to lymphocyte ratio(NLR),the application value in the early diagnosis,severity assessment and disease prognosis of sepsis.Methods:1 Research objects and groups:patients with sepsis who visited our hospital from Nov,2021 to Jan,2023 were collected,according to the severity of the patient’s condition(shock or not),48 patients were divided into septic shock group and 52 patients were divided into the sepsis non-shock group.Disease diagnosis and shock or not are based on the"Saving Sepsis Campaign"issued by American Society of Critical Care Medicine:International Guidelines for the Management of Sepsis and Septic Shock(2016).A total of 50 common infected patients without sepsis who were hospitalized in our hospital during the same period were collected as the common infection group,and 50 healthy subjects who underwent physical examination during the same period were selected as the healthy control group.And by collecting 28-days survival status of sepsis patients,sepsis patients were divided into survival group(n=67 cases)and death group(n=33 cases).IL-6,PCT and CRP were detected within 24 hours of admission in each group,and blood routine test results were collected at the same time to calculate NLR.2 Diagnosis of sepsis:The sex,age,IL-6,PCT,CRP and NLR were compared among the healthy control group,common infection group,sepsis non-shock group and septic shock group.Receiver operator characteristic curve(ROC curve)was established to evaluate the diagnostic performance of single and combined detection for sepsis.3 Sepsis Severity Prediction:The gender,age,IL-6,PCT,CRP and NLR were compared between the sepsis non-shock group and the shock group,perform correlation analysis on the laboratory indicators of statistically significant differences and other indicators,do combined detection based on the analysis results,apply ROC curve to analyze the diagnostic efficiency of single and combined detection indicators in predicting the severity of patients with sepsis.4 Prognosis of sepsis:The gender,age,shock or not,IL-6,PCT,CRP and NLR were compared between the survival group and the death group,do combined detection through by correlation analysis results,apply ROC curve to analyze the diagnostic efficiency of single and combined detection indicators in the prognosis of patients with sepsis.Results:1 Diagnosis of sepsis:The levels of IL-6,PCT,CRP and NLR in the four groups were septic shock group>sepsis non-shock group>infection group>healthy control group,and the differences among the four groups were statistically significant(P<0.05).Among them,PCT and IL-6 had statistically significant differences between any two groups(P<0.05),while other indexes had no significant difference between any two groups(P>0.05).The ROC curve analysis shows that:In the single test,when the best cut-off value of IL-6 is 67.94pg/ml,the area under the ROC curve is largest(AUC=0.879),second only to PCT;The area under the ROC curve and the highest specificity of PCT were 0.919 and 84.0%respectively,and its sensitivity(89.0%)was second only to CRP,and the best cut-off value at this time was 1.72ng/ml;When the best cut-off value of CRP was 25.94mg/L,the highest sensitivity was 91.0%,but the specificity is only 61.0%;When the best cut-off value of NLR was 5.44,the higher sensitivity was 86.0%,but the specificity is only 62.0%.In the combined detection,the area under the ROC curve of IL-6 combined with PCT was the largest(AUC=0.911);the highest sensitivity of IL-6 combined with CRP was 84.0%;the highest combined specificity of the four items was 90.0%.2 Sepsis severity prediction:The levels of PCT and IL-6 in the septic shock group were significantly higher than sepsis non-shock group,and the difference was statistically significant(P<0.05).The results of correlation analysis showed that there were correlations between IL-6 and PCT,CRP and NLR,and between PCT and IL-6,CRP and NLR(P<0.05).Among them,the correlation between IL-6 and PCT was the largest(r_s=0.701,P=0.000).The results of ROC curve analysis showed that the combined detection of IL-6,PCT,CRP and NLR,the largest area under the ROC curve(AUC=0.708),and the highest sensitivity was 91.7%.In the combination of two items,the sensitivity of IL-6 combined with CRP was the highest(85.4%),which was greater than that of IL-6 single test(75.0%);The specificity of IL-6 combined with NLR was the highest(80.8%),which was significantly higher than that of IL-6 single detection(57.7%);The area under the ROC curve of IL-6 combined with PCT was the largest(AUC=0.695),which was greater than that of the two single tests(0.680 and0.640,respectively).3 Sepsis prognosis:The proportion of shock patients in the death group was significantly greater than that in the survival group,and the difference was statistically significant(P<0.05).The level of IL-6 in the death group was significantly higher than that in the survival group(P<0.05).The results of correlation analysis showed that IL-6 was correlated with PCT,CRP and NLR(P<0.05),Among them,the correlation between IL-6 and PCT was the largest(r_s=0.577,P=0.000).The results of the ROC curve analysis showed that,the area under the ROC curve of IL-6 combined with PCT was the largest and the specificity was the highest(0.653,70.1%respectively);the highest sensitivity of IL-6 combined with NLR was 72.7%,and the area under the ROC curve was 0.633;the area under the ROC curve of combined detection of IL-6,PCT and NLR was low;neither IL-6 combined with CRP nor the combination of four items had statistical significance(P>0.05).Conclusion:1 Auxiliary diagnosis of sepsis:PCT has the highest specificity and CRP has the highest sensitivity among individual tests;combined detection can improve the diagnostic value of individual tests,and the combined detection of four items has the highest specificity.2 Assessing the severity of sepsis:the combined detection of IL-6,PCT,CRP and NLR has certain clinical value and the highest sensitivity in evaluating the severity of sepsis,and IL-6 combined with NLR has the highest specificity.3 Predicting the prognosis of sepsis:single and combined detection has no obvious predictive value. |
