肠道屏障功能血清指标对脓毒症病情严重程度及预后的预测价值OA

Objective To investigate the value of serum intestinal barrier function indicators in predicting the severity and prognosis of sepsis.Methods A retrospective analysis was conducted on the clinical data of 188 sepsis patients admitted to the Department of Intensive Care Unit(ICU),Nanjing Hospital of Chinese Medicine from January 2023 to April 2025.According to disease severity,patients were divided into septic non-shock group(n=119)and septic shock group(n=69),and according to 28-day survival status,they were divided into survival group(n=149)and death group(n=39).Serum intestinal barrier function indicators,including endotoxin,D-lactic acid,and diamine oxidase(DAO),were compared between the two groups;meanwhile,age,gender,infection site,underlying diseases,peripheral white blood cell count(WBC),platelet count(PLT),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),lactic acid(Lac),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,and Sequential Organ Failure Assessment(SOFA)score were also compared.Multivariate logistic regression was used to analyze the factors influencing sepsis severity and prognosis.Spearman correlation analysis was used to assess the relationship between serum intestinal barrier indicators and sepsis severity as well as the prognosis.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of these indicators for sepsis severity and prognosis.Results Among 188 sepsis patients,the incidence of septic shock was 36.7％,and the 28-day mortality rate was 20.7％.Significant differences were observed between the septic shock group and the septic non-shock group,as well as between the survival group and the death group,in WBC,PLT,IL-6,hs-CRP,Lac,APACHE Ⅱ score,SOFA score,endotoxin,D-lactate,and DAO(both P＜0.05).Multivariate logistic regression analysis showed that endotoxin(OR=1.326,95％CI=1.157-1.520,P＜0.05),D-lactate(OR=1.241,95％CI=1.114-1.382,P＜0.05),and APACHE Ⅱ score(OR=1.090,95％CI=1.004-1.184,P＜0.05)were independent risk factors for septic shock.Endotoxin and D-lactate were positively correlated with sepsis severity(r=0.518 and 0.540,all P＜0.001).Additionally,endotoxin(OR=1.159,95％CI=1.057-1.271,P＜0.05),D-lactate(OR=1.127,95％CI=1.024-1.240,P＜0.05),and SOFA score(OR=1.186,95％CI=1.022-1.377,P＜0.05)were independent risk factors for 28-day mortality.Endotoxin and D-lactate were positively correlated with poor prognosis of sepsis(r=0.468 and 0.442,all P＜0.001).ROC curve analysis showed that the combined detection of endotoxin and D-lactate had higher sensitivity,higher specificity,and greater area under the curve(AUC)in predicting sepsis severity than APACHE Ⅱ score alone(AUC 0.891 vs.0.679,P＜0.001),and also outperformed SOFA score alone in predicting 28-day mortality(AUC 0.873 vs.0.771,P＜0.001).Conclusion Endotoxin and D-lactate are independent risk factors for septic shock and 28-day mortality in sepsis patients.The combined detection of them has certain predictive value for assessing the severity and prognosis of sepsis.