Abstract
Objective To investigate the predictive value of serum procalcitonin (PCT)combined with soluble triggering receptor expressed on myeloid cells-1 (sTREM-1)and soluble CD 14 subtype (Presepsin)levels for 28-day mortality among patients with sepsis. Methods A total of 97 patients with sepsis receiving inpatient treatment in Department of EICU or Department of Infectious Diseases,Central Hospital of Jinhua from July 2014 to April 2016 were enrolled. Demographic data of the patients were collected. The serum levels of CRP,PTC,sTREM-1 and Presepsin were measured on the first day after admission. All of them were followed up for 28 days for investigating the survival status. Pearson correlation analysis was conducted to analyze the correlation of serum levels of PCT,sTREM-1 and Presepsin with APACHEⅡ. The influencing factors of 28-d mortality in sepsis patients were explored and the Logistic regression equation of serum levels of PCT,sTREM-1 and Presepsin were calculated by multivariate Logistic regression analysis. The receiver operating characteristic (ROC)curves for evaluating prognosis of patients with sepsis by APACHE Ⅱ score,serum levels of PCT,sTREM-1 and Presepsin alone,serum levels of PCT,sTREM-1 and Presepsin jointly were drawn. Results According to the follow-up results,the patients were divided into death group 〔28 cases (28. 9％)〕and survival group (69 cases). The APACHE Ⅱ score,serum levels of CRP,PCT, sTREM-1 and Presepsin of death group were higher than those of survival group (P < 0. 05). Serum levels of PCT,sTREM -1,Presepsin were positively correlated with APACHE Ⅱ score (P < 0. 05). Multivariate Logistic regression analysis showed that APACHE Ⅱ score 〔OR = 1. 13,95％ CI (1. 01,1. 64)〕and serum levels of PCT 〔OR = 1. 66,95％ CI (1. 14,2. 53)〕, sTREM-1 〔OR = 2. 54,95％ CI (1. 14,5. 83)〕,Presepsin 〔OR = 25. 11,95％ CI (1. 58,79. 7)〕were the influencing factors of 28-d mortality in sepsis patients (P < 0. 05). The area under the ROC curve (AUC)of 28-d mortality in sepsis patients predicted by APACHE Ⅱ score,serum levels of PCT,sTREM-1 and Presepsin was 0. 90 〔95％ CI (0. 82,0. 95)〕, 0. 87 〔95％ CI (0. 78,0. 93)〕,0. 90 〔95％ CI (0. 82,0. 95)〕and 0. 85 〔95％ CI (0. 77,0. 92)〕,respectively. The Logistic regression equation of serum levels of PCT,sTREM-1 and Presepsin was Y =-1. 2189 + 0. 03296 × PCT + 0. 06125 × sTREM-1 + 0. 1968 × Presepsin,and the AUC of 28-d mortality in sepsis patients predicted by it was 0. 99 〔95％ CI (0. 94,1. 00)〕. The AUC of 28-d mortality in sepsis patients predicted by serum levels of PCT,sTREM-1 and Presepsin jointly was greater than that predicted by APACHE Ⅱ score,serum levels of PCT,sTREM-1 and Presepsin alone (P <0. 05). Conclusion The value of serum levels of PCT,sTREM-1 and Presepsin in predicting the 28-d mortality in sepsis patients is better than that of single index,which has important reference value and clinical significance,and is helpful for clinical decision-making.关键词
脓毒症/死亡率/预测/降钙素原/可溶性髓样细胞触发受体-1/可溶性CD14亚型Key words
Sepsis/Mortality/Forecasting/Procalcitonin/Soluble triggering receptor expressed on myeloid cells -1/Soluble CD14 subtype分类
医药卫生
