RESUMO
Objective To investigate the relationship between the clinical invasive interventions during hospitalization and the admission indicators within 24 hours with death within 28-day after admission in sepsis patients. Methods The clinical data of 112 sepsis patients who were admitted to the First Medical Center of Chinese PLA General Hospital from Jan. 2016 to Dec. 2018 were analyzed retrospectively. Four clinical invasive interventions (mechanical ventilation, tracheal intubation, continuous renal replacement therapy[ CRRT] and deep vein catheterization) and admission indicators (including demographic characteristics, vital signs and laboratory indexes) that may have an impact on the death of sepsis patients were selected during hospitalization, and the 28-day survival of patients was taken as the outcome variable. The above parameters were compared between the survival group (n=81) and the death group (n=31), and the independent risk factors of sepsis death within 28-day after admission were determined by multivariate logistic regression analysis. Results There were statistically significant differences in age, the sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, IL-6, procalcitonin, aspartate aminotransferase, CRRT and deep vein catheterization between the two groups (all P<0.05). The results of the multivariate logistic regression analysis revealed that high IL-6 level (odds ratio[OR] =1.001, P=0.011), low procalcitonin level (OR=0.966, P=0.005) and CRRT (OR=6.846, P=0.002) were independent risk factors of death within 28-day after admission in sepsis patients. Conclusion Sepsis patients with increased IL-6 level, decreased procalcitonin level and CRRT during hospitalization have a higher risk of death within 28-day after admission. Close observation and dynamic monitoring of changes in IL-6, procalcitonin and renal function will be beneficial for early identification of septic patients who might have adverse clinical outcomes. The proportions of essential invasive interventions such as mechanical ventilation, tracheal intubation, CRRT, and deep venous catheterization are higher in dead patients, so clinicians need to carefully evaluate and accurately grasp the balance point..
RESUMO
Sepsis is a serious life-threatening multiple organ dysfunction disease with high morbidity and mortality, how to conquer sepsis is a worldwide problem. According to the latest international consensus, the occurrence of sepsis is associated with the host's immune response, so reasonable and accurate use of immune regulating scheme for comprehensive treatment of sepsis will be the research hot spot. The pathogenesis of sepsis can be simply divided into the stage of systemic inflammatory response and stage of compensatory anti-inflammatory response, corresponding immune regulating measures are anti-inflammatory therapy and immunostimulation therapy respectively. Although immunotherapy has reduced the mortality of patients to some extent, how to maximize the survival rate of sepsis patients is still a difficulty. Currently, immune combined therapy is carried out widely in the field of cancer treatment, and the therapeutic effect is significant, but in the field of sepsis, immune combined therapy research is less. This article summarizes the recent 10 years' advances in immune combined therapy for sepsis, including the combination between glucocorticoid, that between interleukin and immune checkpoint inhibitor, and that between both Chinese medicine Xuebijing injection and thymosin alpha 1 and other drugs, etc. Immune combined therapy has achieved initial success in the field of sepsis, and shows a great potential and development space. It is believed that in the near future, immune combined therapy is expected to become a new therapeutic strategy and bring breakthrough for the treatment of sepsis.