Objective: To evaluate early prediction value of IPS combined with SchE and D-dimer detection for infection and survival in critically ill patients. Methods: 199 critically ill patients admitted to the emergency intensive care unit (EICU) of our hospital from December 2018 to December 2019 were retrospectively analyzed, including 110 infection patients (infection group) and 89 non-infection patients (non-infection group). According to the survival, the infection group was divided into death group (68 cases) and survival group (42 cases). The IPS, APACHE II, SOFA and SchE, D-dimer expression levels were detected and compared; Univariate and logistic regression analysis were used to evaluate the independent prognostic factors. Results: The IPS and APACHE II of patients in the infected group were higher than those in the non-infected group, the level of SchE was lower than that in the non-infected group, and the level of D-dimer was higher than that in the non-infected group (P < 0.001). IPS, SOFA, APACHE II , SchE, D-dimer, invasive mechanical ventilation, septic shock, and ICU length of stay had significant influence on the prognosis of critically ill patients (P < 0.001). Logistic regression analysis showed that IPS (OR = 2.821, 95% CI 1.501 - 5.227), SOFA (OR = 5.078, 95% CI 3.327 - 7.690), APACHE II (OR = 14.308, 95% CI 8.901 - 21.893), SchE (OR = 0.223, 95% CI 0.165 - 0.291), D-dimer ( OR = 2.10 , 95% CI 1.55 - 2.85 ) , septic shock (OR = 9.948, 95% CI 7.012 - 17.012) were independent factors affecting the prognosis of critically ill patients with infection ( P < 0.001 ) . Conclusion: IPS and D-dimer expression level in infected patients were increased and SchE decreased significantly compared with those in non-infected patients, and they significantly correlated with disease severity of infected patients and could be early prediction for prognosis.
Critically ill infection has no strong clinical characteristics at the initial stage of the disease, but the disease develops rapidly and has a very high fatality rate [
The clinical data of 202 critically ill patients admitted to the EICU of our hospital from December 2018 to December 2019 were retrospectively analyzed, among which 3 cases were incomplete and 199 cases were included. Including 110 infected critically ill patients (infected group) and 89 non-infected critically ill patients (non-infected group); According to the survival prognosis of the infected group, it was divided into 68 cases in the death group and 42 cases in the survival group. The 199 patients included 109 males and 90 females. All patients signed informed consent forms, and this study was approved by the Ethics Committee of our hospital.
Inclusion criteria: All patients were critically ill , and patients in the infected group met at least two of the following diagnostic criteria for infection [
Exclusion criteria: 1) patients with severe mental illness or malignant tumor; Serious heart, liver, lung, renal insufficiency or accompanied by metabolic diseases; Serious diseases of the blood system; those who had taken immune preparations in the past half year; the duration of ICU stay was less than 24 hours.
Comprehensive clinical data to collect all the object of study, including gender, age, BMI, IPS [
5 mL peripheral venous blood was extracted from all patients on the first day of hospitalization, and centrifuged at 3500 r/min for 15 min (centrifugation radius was 10 cm) immediately. The supernatant was separated and stored in a refrigerator at −30˚C. Colloidal gold method was adopted [
D-dimer: 5 ml of the patient’s venous blood was extracted after admission, and D-dimer was determined by immunoturbidimetry. The kit adopted the Strumentation Labora-Tory Co., and strictly implemented the use standard on the kit. The normal value was less than 0.3 ng/ml.
SPSS 19.0 software was used for statistical analysis. The measurement data consistent with normal distribution were represented by x ¯ ± s , and the comparison between groups was performed by independent sample T test. The count data were represented by percentage, and the comparison between groups was performed by χ2 test. Measurement data that do not conform to normal distribution were represented by median (quartile) [M (QL, QU)]; Univariate analysis and non-conditional Logistic regression multivariate analysis were performed on factors affecting survival, and P < 0.05 indicated statistically significant differences.
There was no significant difference in general information such asgender, age, body mass index (BMI) between the infected group and the non-infected group (P > 0.05) (
Score of IPS and APACHE II in the infected group was higher than that in the non-infected group (P < 0.001), but there was no significant difference in the SOFA score. (P > 0.05).The SchE expression level of the infected group was lower than that of the non-infected group, and the expression level of D-dimer (OR = 2.10, 95% CI 1.55 - 2.85) was higher than that of the non-infected group (P < 0.001) (
The results of univariate analysis showed that the IPS, SOFA, APACHE II, SchE, D-dimer, whether there is invasive mechanical ventilation, septic shock and length of stay in ICU will have a significant impact on the prognosis of critically ill patients (P < 0.001) (
Logistic regression analysis had been performed, with patient prognosis (survival = 0, death = 1) as the dependent variable, and the statistically significant factors in
Group | Cases | Age (year) | Gender (M/F) | BMI (kg/m2) |
---|---|---|---|---|
Infected | 110 | 69.65 ± 8.43 | 67/43 | 22.74 ± 3.82 |
Non-infected | 89 | 68.95 ± 7.91 | 42/47 | 23.36 ± 3.76 |
t/χ2 | - | 0.939 | 0.978 | 1.508 |
P | - | 0.346 | 0.345 | 0.151 |
Group | Cases | IPS score | SOFA score | APACHE II score | SchE (U/L) | D-dimer (mg/ml) |
---|---|---|---|---|---|---|
Infected | 110 | 17.76 ± 3.56 | 10.26 ± 3.41 | 23.20 ± 4.49 | 3629.62 ± 298.59 | 4.06 ± 1.81 |
Non-infected | 89 | 12.52 ± 4.38 | 9.79 ± 2.40 | 17.29 ± 4.13 | 5304.89 ± 412.67 | 1.07 ± 0.39 |
t | - | 8.734 | 1.702 | 8.708 | 30.418 | 56.060 |
P | - | <0.001 | 0.093 | <0.001 | <0.001 | <0.001 |
Factor | Death group (n = 68) | Survival group (n = 42) | t/χ2 | P |
---|---|---|---|---|
Sex (M/F) | 46/22 | 29/13 | 0.306 | 0.608 |
Age (year) | 69.35 ± 8.61 | 69.95 ± 9.11 | 1.109 | 0.302 |
BMI (kg/m2) | 22.46 ± 3.52 | 22.82 ± 3.56 | 0.644 | 0.509 |
IPS | 21.75 ± 3.75 | 15.61 ± 3.34 | 9.057 | <0.001 |
SOFA | 12.73 ± 3.47 | 9.24 ± 2.77 | 5.627 | <0.001 |
APACHE II | 26.78 ± 4.67 | 21.51 ± 4.31 | 5.802 | <0.001 |
SchE (U/L) | 3220.25 ± 306.41 | 3827.52 ± 279.45 | 9.213 | <0.001 |
D-dimer (mg/ml) | 5.06 ± 1.29 | 1.10 ± 0.41 | 19.164 | <0.001 |
Mechanical ventilation (Y/N) | 68/0 | 29/11 | 10.172 | 0.001 |
Septic shock (Y/N) | 55/13 | 5/37 | 6.213 | 0.025 |
ICU admission [d, M (QL, QU)] | 4.30 (1.012, 14.102) | 7.13 (244, 11.123) | 2.478 | 0.032 |
Variable | β | S.E. | Wald χ2 | P | OR | 95% CI |
---|---|---|---|---|---|---|
IPS | 1.036 | 0.325 | 10.161 | 0.001 | 2.821 | 1.501 ~ 5.227 |
SOFA | 1.625 | 0.215 | 57.125 | 0.000 | 5.078 | 3.327 ~ 7.690 |
APACHE II | 2.658 | 0.241 | 121.640 | 0.000 | 14.308 | 8.901 ~ 21.893 |
SchE | -1.526 | 0.145 | 110.757 | 0.000 | 0.223 | 0.165 ~ 0.291 |
D-dimer (mg/ml) | 0.743 | 0.156 | 3.851 | 0.000 | 2.10 | 1.55 ~ 2.85 |
septic shock | 2.365 | 0.219 | 116.620 | 0.000 | 9.948 | 7.012 ~ 17.012 |
(OR = 14.308, 95% CI 8.901 ~ 21.893), SchE (OR = 0.223, 95% CI 0.165 ~ 0.291), D-dimer (OR = 2.10, 95% CI 1.55 ~ 2.85), septic shock (OR = 9.948, 95% CI 7.012 ~ 17.012), are independent factors affecting the prognosis of critically ill patients (P < 0.001) (
The pathogenesis of critical illness infection in ICU may be related to the serious disorder of physiological function and the invasion of pathogens caused by the decline of immune function. Previous studies have confirmed that APACHE II, SOFA and IPS are important diagnostic parameters for infectious diseases, but their diagnostic value in critical infectious diseases has not yet a very clear conclusion [
The results of this study showed that scores of the IPS and APACHE II of the infected group were higher than those of the non-infected group (P < 0.001), and the SOFA score of the infected group was higher than that of the non-infected group, but there was no significant difference (P > 0.05) (
The results of this study also suggested that SchE expression loss and D-dimer overexpression could promote the occurrence and development of infection in severe patients and had significant impact on the prognosis of patients. Based on previous studies, the authors concider that SchE expression loss may occur in critically infected patients through the following mechanisms: on one hand, there is an inflammatory response in critically infected patients, which will further induce the release of a large amount of acetylcholine, resulting in the consumption of SchE; On the other hand, severe lipoprotein metabolism disorders were observed in critically infected patients, which affected the transport capacity of SchE in circulating blood and finally showed SchE level decrease in peripheral blood [
For acute sepsispatients, disseminated intravascular coagulation syndrome (DIC) is a manifestation of coagulation failure, and early diagnosis of this syndrome has become one of the problems that cannot be ignored [
In conclusion, IPS and D-dimer expression level of critically ill infected patients were significantly higher than those of non-infected patients, and SchE level was significantly lower, which was significantly correlated with the severity of infection and prognosis, and was an independent risk factor affecting the prognosis of patients. Emphasis on the detection of SchE and D-dimer is important for early prediction for the prognosis of severinfectedpatients. However, since this study is a single-center retrospective study, the sample size is fair, and the influence of infection site and other factors on the prognosis of patients is not fully considered, which may lead to certain deviations in the results. Further multi-center prospective studies can be carried out in the later period to further verify the conclusions of this study.
The authors declare no conflicts of interest regarding the publication of this paper.
Zhao, Q., Qi, H.J., Guo, H., Shen, Z.S. and Li, J.G. (2020) The Prediction Value of the Infection Probability Score (IPS) Combined with Serum Cholinesterase and D-Dimer Detection for Infection and Survival in Critically Ill Patients. Case Reports in Clinical Medicine, 9, 228-235. https://doi.org/10.4236/crcm.2020.98032