ABSTRACT
Objective:To investigate the predictive value of different glycemic variability indexes within 6 hours on the short-term prognosis of septic shock patients.Methods:A retrospective study was conducted. The 133 patients with septic shock admitted to intensive care unit (ICU) of Nanjing Hospital Affiliated to Nanjing Medical University from December 2014 to December 2019 were enrolled. Patients with septic shock admitted to ICU died during hospitalization were enrolled in the death group and others in the survival group. General data of the patients including gender, age, underlying disease, site of infection, duration of mechanical ventilation, length of ICU stay, whether to use continuous renal replacement therapy (CRRT) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores within 24 hours were collected. The blood glucose (GLUadm), mean arterial pressure (MAP), serum creatinine (SCr) and procalcitonin (PCT) were recorded at ICU admission. The patients admitted to ICU received bundle therapy within 6 hours and blood glucose was observed every 2 hours. The blood glucose difference (GLUdif), average blood glucose (GLUave), blood glucose standard deviation (GLUsd) and blood glucose variation coefficient (GLUcv) within 6 hours were calculated. Multivariate Logistic regression analysis was used to analyze the prognostic factors of short-term prognosis of patients with septic shock, and receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of glycemic parameters for short-term prognosis of septic shock patients.Results:A total of 133 patients with septic shock were admitted to ICU, among them 87 patients survived and 46 patients died during the ICU hospitalization. Compared with the survival group, the SCr at ICU admission and APACHEⅡ score within 24 hours were significantly higher in the death group [SCr (μmol/L): 208.5 (143.0, 286.5) vs. 172.0 (91.0, 234.0), APACHEⅡ score: 30.28±6.67 vs. 24.03±5.90, both P < 0.05], the length of ICU stay was shorter [days: 4.00 (2.00, 10.25) vs. 9.00 (4.00, 13.00), P < 0.01]. However, there were no significant differences in the baseline data of gender, age, underlying disease, infection site, CRRT ratio, MAP or PCT at ICU admission between the two groups. Compared with the survival group, the GLUsd and GLUcv within 6 hours in the death group were higher [GLUsd (mmol/L): 2.33 (1.95, 3.14) vs. 2.02 (1.66, 2.52), GLUcv: (31.00±7.06)% vs. (23.31±10.51)%, both P < 0.05]. There were no statistically significant differences in the levels of GLUadm, GLUdif or GLUave within 6 hours between the two groups. Multivariate Logistic regression analysis showed that APACHEⅡ score within 24 hours and GLUsd and GLUcv within 6 hours were independent risk factors of the short-term prognosis of septic shock patients [APACHEⅡ score: odds ratio ( OR) = 1.173, 95% confidence interval (95% CI) was 1.095-1.256, P = 0.000; GLUsd: OR = 1.465, 95% CI was 1.038-2.067, P = 0.030; GLUcv: OR = 1.089, 95% CI was 1.043-1.138, P = 0.000]. ROC curve analysis showed that GLUsd and GLUcv within 6 hours both had certain predictive value for the short-term prognosis of septic shock patients, the area under ROC curve (AUC) of GLUcv within 6 hours was higher than that of APACHEⅡ score (0.765 vs. 0.753), and AUC of GLUsd within 6 hours was close to APACHEⅡ score (0.629 vs. 0.753); and the diagnostic value of GLUsd combined with GLUcv within 6 hours was higher than the two respectively (AUC: 0.809 vs. 0.629, 0.765), the sensitivity was 97.8%, and the specificity was 66.7%. Conclusion:GLUsd combined with GLUcv within 6 hours can be used to estimate the short-term prognosis of septic shock patients.
ABSTRACT
Objective:To investigate the predictive value of serum thyroid hormone in the short-term prognosis of patients with septic shock..Methods:The 133 patients with septic shock admitted to Intensive Care Unit (ICU) of Nanjing Hospital of Nanjing Medical University were enrolled. Data of patient’s general clinical information, acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), serum triiodothyronine ( T3 ), thyroxine (T4), free triiodothyronine (FT3) , free thyroxine (FT4) and thyroid stimulating hormone(TSH) in 24 h were collected, and the ratio of T3 to FT3 (T3/FT3) was calculated. The patients were divided into the survival group and death group according to the prognosis during ICU hospitalization. Univariate and multivariate analyses were used to analyze the prognostic factors of patients with septic shock. The receiver operating characteristic (ROC) curve and Kaplan-Meier analysis were plotted to evaluate the diagnostic efficacy of serum thyroid hormone for the short-term prognosis of patients with septic shock.Results:Compared to the survival group, FT3, T3 and T3/FT3 were significantly lower in the death group [1.73 (1.54, 2.52) vs. 1.32 (0.94, 1.54) pmol/L, 0.70 (0.56, 0.79) vs. 0.33 (0.25, 0.43) nmol/L, 318.18(299.44, 448.05) vs. 250.00 (192.31, 313.92), respectively; all P < 0.05 ]. The levels of serum T3 and FT3 were significantly correlated with the APACHEⅡ score in patients with septic shock (FT3: r = -0.25, P= 0.004; T3: r = - 0.24, P= 0.006). Binary Logistic regression analysis showed that FT3, T3 and T3/FT3 were independent risk factors of the short-term prognosis of patients with septic shock [FT3: OR = 6.533, 95% CI: 0.687 - 62.157, P = 0.012; T3: OR = 0.529, 95% CI: 0.372 - 0.975, P= 0.000; T3/FT3: OR = 1.719, 95% CI: 1.007 - 1.931, P= 0.002]. ROC curve analysis showed that FT3, T3 and T3/FT3 all had certain predictive value for the short-term prognosis of patients with septic shock, and the diagnostic value of T3 was the largest [AUC = 0.874, 95% CI: 0.794-0.954, P= 0.000]. The Kaplan-Meier curve showed a significantly higher survival rate in patients with T3 greater than 0.535 nmol/L than patients with T3 less than 0.535 nmol/L. Conclusions:The serum levels of thyroid hormone T3 and FT3 are closely related to the severity of septic shock. T3 is an effective ICU mortality during hospitalization prognostic indicator for patients with septic shock, which is better than FT3 and T3/FT3.