关键词: 降钙素原, D-二聚体, 乳酸, 白蛋白, 急性生理与慢性健康评分Ⅱ, 序贯器官衰竭评分, 脓毒症

Abstract:

Objective To investigate the roles of D-dimer（DD），lactic acid（Lac），albumin（Alb），procalcitonin（PCT）combined with clinical scores [acute physiology and chronic health evaluationⅡ（APACHEⅡ）and sequential organ failure assessment（SOFA）scores] in the diagnosis and progression assessment of sepsis. Methods Totally，113 patients with sepsis and 87 patients with septic shock in the Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from January to December 2023 were enrolled. The clinical data were collected，and the levels of PCT，DD，Lac and Alb were determined. According to the PCT determination results，the patients were classified into PCT 2-10 ng·mL^-1 group（95 cases），PCT 10-30 ng·mL^-1 group（51 cases），PCT 30-100 ng·mL^-1 group（32 cases）and PCT >100 ng·mL^-1 group（22 cases）. Multivariate Logistic regression analysis was used to evaluate the influencing factors of septic shock. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of single and combined determinations of each index in diagnosing septic shock. Results The levels of PCT，DD，Lac，SOFA score and APACHEⅡscore in septic shock group were higher than those in sepsis group（P<0.05），while the level of Alb was lower than that in sepsis group（P<0.05）. There was statistical significance in the levels of DD among different PCT levels in each group（P<0.001），and the level of DD was the highest in PCT 10-30 ng·mL^-1 group. The levels of Lac and SOFA score were increased successively in PCT 2-10 ng·mL^-1 group，PCT 10-30 ng·mL^-1 group，PCT 30-100 ng·mL^-1 group and PCT >100 ng·mL^-1 group（P<0.05），while the levels of Alb were decreased successively（P<0.05）. There was no statistical significance in APACHEⅡscore among different PCT levels in each group（P>0.05）. Increased Lac，SOFA score and APACHEⅡscore were risk factors for septic shock [odds ratios（OR）were 1.166，2.311 and 1.266，95% confidence intervals（CI） were 0.988-1.419，1.708-3.333 and 1.010-1.601，respectively，P<0.05）. The areas under curves（AUC） of single and combined determinations of PCT，DD，Lac，Alb，APACHEⅡscore and SOFA score for diagnosing septic shock were 0.613，0.622，0.690，0.572，0.791，0.809 and 0.867，respectively. Conclusions PCT，DD，Lac，Alb，APACHEⅡscore and SOFA score are related to the condition of patients with sepsis，and the combined determination is helpful for the early diagnosis of septic shock.

Key words: Procalcitonin, D-dimer, Lactic acid, Albumin, Acute physiology and chronic health evaluation Ⅱscore, Sequential organ failure assessment score, Sepsis