[Value of detection of pentraxins 3 value combined with measurement of vascular lung water index in prognosis of patients with sepsis].

OBJECTIVE:To evaluate prognostic value of pentraxin3 ( PTX3 ) content combining with extravascular lung water index ( EVLWI ) in patients with sepsis. METHODS:A retrospective analysis of complete clinical data of septic patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2014 was conducted. These patients were divided into two groups, survival group and death group, according to the outcome on the 28th day. Pulse index continuous cardiac output ( PiCCO ) was used to record the levels of EVLWI on the 1st, 2nd and 3rd day of intensive care unit ( ICU ) admission. The plasma level of PTX3 was measured simultaneously by enzyme-linked immunosorbent assay ( ELISA ). At the same time, acute physiology and chronic health evaluation II ( APACHEII) score and sequential organ failure assessment ( SOFA ) were calculated. Correlation analysis between plasma PTX3 and EVLWI values was performed, receiver operating characteristic curve ( ROC ) was drawn, and the prognostic value of each parameter was assessed finally. RESULTS:A total of 74 septic patients were enrolled, with 41 cases in the survival group and 33 cases in the non-survival group. Blood lactate, APACHEII, SOFA scores in the non-survival group were significantly higher than those of the survival group at ICU admission, and the length of ICU stay was significantly shorter than that of the survival group, while differences of the other clinical characteristics between two groups were not statistically significant. The plasma PTX3 level gradually declined with time in both groups, and plasma PTX3 at 1, 2, 3 days after ICU admission in non-survival group were significantly higher than those in survival group [ PTX3 ( μg/L ) at 1 day: 46.3±10.5 vs. 19.4±6.5, t = -13.486, P = 0.000; 2 days: 34.8±10.7 vs. 17.7±8.4, t = -8.284, P = 0.000; 3 days: 23.9±11.2 vs. 15.6±7.9, t = -5.036, P = 0.000 ]. EVLWI gradually declined in survival group, but increased in death group. EVLWI at 1, 2, 3 days after ICU admission in non-survival group were significantly higher than those in survival group [ EVLWI ( mL/kg ) at 1 day: 12.12±4.31 vs. 10.02±2.87, t = -2.502, P = 0.023; 2 days: 13.67±4.95 vs. 9.08±2.89, t = -5.188, P = 0.000; 3 days: 14.51±5.06 vs. 8.09±2.50, t = -7.126, P = 0.000 ]. PTX3 at 1, 2, 3 days after ICU admission showed a significant positive correlation with EVLWI ( r1 = 0.747, r2 = 0.719, r3 = 0.705, all P = 0.000 ). ROC curve analysis showed that the area under the ROC ( AUC ) of PTX3 at 1 day was 0.845±0.045, at the cut-off point of 23.0 μg/L, PTX3 showed a sensitivity of 84.8%, a specificity of 74.1%, a negative predictive value of 85.81%, and a positive predictive value of 72.42%. AUC of EVLWI at 3 days was 0.838±0.048, at the cut-off point of 10.5 mL/kg, EVLWI showed a sensitivity of 83.9%, a specificity of 82.9%, a negative predictive value of 86.45%, and a positive predictive value of 79.79%. Their sensitivities and specificities were found to be better than APACHEII, SOFA score. AUC of PTX3 combined with EVLWI at 1 day was 0.886±0.038. On the 1st day after ICU admission, with combination of the two indicators, cut-off point was found to be 0.312, a sensitivity of 86.8%, a specificity of 85.4%, a negative predictive value of 88.93%, and a positive predictive value of 82.72%. On the 3rd day after ICU admission, AUC of PTX3 combined with EVLWI was 0.856±0.046, and showed a cut-off of 0.471 for the prognosis of sepsis, a sensitivity of 85.8%, a specificity of 85.4%, a negative predictive value of 87.97%, and a positive predictive value of 82.50%. Compared with other single index, a combination of above mentioned two indexes showed a better sensitivity and specificity. CONCLUSIONS:PTX3 can serve as a novel prognostic indicator at early stage in septic patients. Combined with EVLWI, it shows important value in predicting prognosis of septic patients, and it also provides guidance in treatment of high-risk patients.