Wang Jia, Wang Junyu, Wei Bing
Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Capital Medical University, Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
Ther Clin Risk Manag. 2021 Jan 15;17:55-63. doi: 10.2147/TCRM.S291242. eCollection 2021.
Studies have shown that a variety of blood inflammatory markers can be used to assess the criticality of patients with sepsis. In this study, the blood inflammatory factors related to the sepsis survival group and the death group were compared and analyzed, which can be used by clinicians to adjust sepsis patient treatment.
This study used retrospective methods to analyze the medical records of 428 patients with sepsis. The test of blood samples includes the patient's age, gender, hospital stays, the concentration of procalcitonin (PCT), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio (NLR), D-dimer (DD), Fe, and hemoglobin (Hb) in the venous blood of patients with sepsis. The detection of PCT methods adopts the sandwich immunofluorescence (IF). ROC curve was used for the diagnosis and analysis of various factors of sepsis.
Among all the patients with sepsis, 133 patients died, with a mortality rate of 31.07%. Analysis of related inflammatory indicators and the patient's baseline parameters showed the patients age, the values of PCT, ANC, NLR, and DD in death group were statistically higher than those in survival group (all p values were <0.05). However, the concentration of Fe and ALC show an opposite trend between the two groups. Regression analysis results showed the patient's gender, Fe, PCT, ANC, and DD are all independent prognostic factors for patients with sepsis. The results of the ROC curve of related diagnostic indicators show that DD has the best area under curve (AUC=0.700), the most sensitive index is ANC (74.44), and the most specific index is PCT (89.80). The results of the two-by-two combined diagnosis of the four indicators showed that the PCT+DD group had better AUC (0.748) and specificity (78.23), and the Fe+DD group had the best sensitivity (75.89).
In this study, the patient's gender and the inflammation-related markers of Fe, PCT, ANC, and DD can be used as independent risk factors affecting the prognosis of patients with sepsis. The combination of PCT+DD and Fe+DD has high diagnostic value for patients with sepsis.
研究表明，多种血液炎症标志物可用于评估脓毒症患者的危急程度。在本研究中，对脓毒症存活组和死亡组的血液炎症因子进行了比较和分析，可供临床医生用于调整脓毒症患者的治疗方案。
本研究采用回顾性方法分析了428例脓毒症患者的病历。血液样本检测包括患者的年龄、性别、住院时间、降钙素原（PCT）浓度、绝对中性粒细胞计数（ANC）、绝对淋巴细胞计数（ALC）、中性粒细胞与淋巴细胞比值（NLR）、D-二聚体（DD）、铁（Fe）以及脓毒症患者静脉血中的血红蛋白（Hb）。PCT检测方法采用夹心免疫荧光法（IF）。采用ROC曲线对脓毒症的各项因素进行诊断和分析。
在所有脓毒症患者中，133例死亡，死亡率为31.07%。对相关炎症指标和患者基线参数的分析表明，死亡组患者的年龄、PCT、ANC、NLR和DD值在统计学上高于存活组（所有p值均<0.05）。然而，两组之间Fe和ALC的浓度呈现相反趋势。回归分析结果显示，患者的性别、Fe、PCT、ANC和DD均为脓毒症患者的独立预后因素。相关诊断指标的ROC曲线结果显示，DD的曲线下面积（AUC）最佳（AUC=0.700），最敏感指标为ANC（74.44），最特异指标为PCT（89.80）。四项指标两两联合诊断结果显示，PCT+DD组的AUC（0.748）和特异性（78.23）较好，Fe+DD组的敏感性最佳（75.89）。
在本研究中，患者的性别以及Fe、PCT、ANC和DD等炎症相关标志物可作为影响脓毒症患者预后的独立危险因素。PCT+DD和Fe+DD联合检测对脓毒症患者具有较高的诊断价值。
