| Research background and purpose:Pulmonary sepsis is defined as sepsis that originates from the lung.With the rapid rise in China’s aging population,the incidence rate of pulmonary sepsis will increase in the next few years.The most common site of primary infection of sepsis is the lungs,Pulmonary sepsis has a higher mortality rate than intra-abdominal and urinary tract sepsis.Pulmonary sepsis has become the type of sepsis with the highest proportion in ICU recently.In recent years,multi-drug resistant pathogens have been increasing,in addition,a new diagnostic standard for sepsis was released,thus a higher proportion of patients with pulmonary infection meet the diagnosis of sepsis.Some patients of which will deteriorate to the stage of septic shock.Pulmonary sepsis shock is one of the diseases with the worst prognosis among respiratory diseases,the death rate of which is extremely high.Only by timely intervention in the early stage of pulmonary sepsis can effectively reduce its mortality and improve its prognosis.The purpose of this article is to explore the clinical characteristics of patients with pulmonary septic shock,and analyze the risk factors of his occurrence and deterioration,at the same time,to explore the predictive value of SOFA score,APACHE II score,PSI score,CURB-65 score and some laboratory indicators on prognosis,So as to identify and treat high-risk patients in time and improve the prognosis.Method:A retrospective analysis was conducted to pulmonary septic shock patients who were admitted to the Intensive Care Unit of the First Affiliated Hospital of Hainan Medical University from from January 1,2017 to December 31,2022;Patients with pulmonary septic shock who met the inclusion criteria during the study period were selected as the study subjects.Some relevant information(such as medical history and laboratory examination data,etc)of which were collected.According to the survival outcome at 28 days,the patients were divided into survival group and non-survivor group.SPSS 26.0 was used,and P < 0.05 was defined as statistically significant.Variables with statistical differences in univariate analysis were studied by multivariate logistic regression analysis to find out independent risk factors that affect the prognosis of patients with pulmonary sepsis and construct regression model.ROC curves were drawn to evaluate the prognostic value of PSI score,CURB-65 score,APACHE II score,SOFA score and some serum biomarkers in patients with pulmonary septic shock.Results:1.A total of 502 patients with pulmonary septic shock were included in the study during the study period,including 235 patients(46.81%)in the non-survival group and 267 patients(53.19%)in the survival group.A total of 360 male patients(71.71%)were included.256 patients(50.10%)had two or more systemic underlying diseases,including 190 patients(80.85%)with two or more systemic underlying diseases in the non-survival group.The median age of the non-survival group was 79 years old(76-87 years old),and the median length of hospital stay was 16 days(9-21days).2.Among 502 patients with pulmonary septic shock,356(70.92%)had fever on the first day of ICU admission,with a median respiratory rate of 29 bpm and a median pulse frequency of 113 bpm.3.Among 502 patients with pulmonary septic shock,310 cases(61.75%)were positive in blood culture,of which 70 cases(13.94%)were acinetobacter baumannii,and 282 cases(56.18%)were positive in sputum culture,among which 94 cases(18.73%)were also positive in acinetobacter baumannii.4.Univariate analysis showed that age,number of underlying diseases,amount of vasoactive drugs used,amount of pleural effusion,awareness of patients,respiratory rate,heart rate,PACHEII score,PSI score,SOFA score,CURB-65 score,multidrug-resistant bacterial infection in blood culture,urine volume,arterial lactic acid,Pa O2/Fi O2,TB,PLT,CREA,BUN,Na,ALB,WBC,NEUT%,HCT,FDP,D-D,BNP had statistical differences(P < 0.05),which were suspected risk factors for the occurrence and development ofpulmonary septic shock(P < 0.05)5.Multivariate binary logistic regression analysis showed that age,NEUT%,D-D,ALB and Na were independent risk factors for death in patients with pulmonary septic shock(P < 0.05).Logistic regression model was constructed by age,NEUT%,D-D,ALB and Na.the Logistic equation of shock warning of pulmonary sepsis was Z=43.779-3.166(age)+0.071(Na)-0.248(ALB)-0.082(D-D)-0.156(NEUT%),and its early warning probability was P=1/(1+e-z).6.The area under ROC curve APACHE Ⅱ score,PSI score,SOFA score,and CURB-65 score were 0.7658,0.7398,0.6632,and 0.6121 to predict the 28-day mortality of patients.APACHEⅡ score predicted the 28-day mortality with 80.58%sensitivity and 74.63% specificity.PSI score predicted the 28-day mortality sensitivity of 79.48% and specificity of 71.67%,SOFA score predicted the 28-day mortality sensitivity of 71.66% and specificity of 69.38%.The CURB-65 score predicted the28-day mortality with a sensitivity of 68.51% and specificity of 72.18%.NEUT%(0.6463),D-D(0.6266),ALB(0.5225),Na(0.5536),NEUT%(56.1%),and specificity(66.8%)predicted 28-day mortality.The sensitivity and specificity of D-D were 55.28% and 67.58% respectively.ALB predicted 28-day mortality with a sensitivity of 52.85% and a specificity of 50.78%.The sensitivity and specificity of Na to predict 28-day mortality were 42.28% and 63.28%.The prediction probability of risk factor regression model for pulmonary septic shock was regarded as a new joint variable,and the ROC curve was plotted.The area under ROC curve for predicting 28-day mortality of patients with pulmonary sepsis was 0.6748,the predicted sensitivity was 67.07%,and the specificity was 62.89%.Conclusions:1.There are several clinical characteristic of patients with pulmonary septic shock,which includes that the proportion of elderly males is more common,These patients usually complicate with multiple systemic diseases in the past.Once transferred to ICU,the condition of multi-drug-resistant bacterial infection deteriorates rapidly,It’s is difficult to reverse patient’s condition,and most patients have fever,shortness of breath and tachycardia.Pulmonary septic shock is the end-stage state of some severe pneumonia essentially.The commonly used clinical serological markers NEUT%,D-D,ALB and sodium have relatively obvious advantages in capturing the change trend of the disease at this stage.2.Independent risk factors affecting prognosis of patients with pulmonary septic shock include age,NEUT%,D-D,ALB,Na.The order to predict the prognosis of patients with pulmonary septic shock is APACHEII score>PSI score>SOFA score>CURB-65 score.The combination of NEUT%,D-D,ALB and Na in blood biochemical markers can improve the prognostic value of patients with pulmonary sepsis than single indicator. |
