正五聚蛋白3联合APACHE Ⅱ评分对急性感染患者脓毒症发生及预后的预测能力评估OA

Objective To explore the predictive value of pentraxin 3(PTX3)combined with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score for sepsis development and adverse outcomes in emergency patients with infection or suspected infection.Methods Patients with acute infection or suspected infection admitted to Rehabilitation Medical College of Capital Medical University,Department of Emergency,China Rehabilitation Research Center,from December 1,2023,to May 11,2025,were enrolled as research subjects.Patients were classified into non-sepsis and sepsis groups according to the Sepsis 3.0 criteria,and sepsis patients were further divided into survivors and non-survivors based on 28-day survival status.Collect the patients'demographic characteristics,underlying diseases[hypertension,coronary heart disease,diabetes,stroke,malignant tumor,atrial fibrillation,chronic kidney disease,chronic obstructive pulmonary disease(COPD),and bedridden status],laboratory findings[white blood cell count(WBC),C-reactive protein(CRP),lactic acid(Lac),procalcitonin(PCT),and PTX3],sequential organ failure assessment(SOFA)score,APACHE Ⅱ score,quick SOFA(qSOFA)score,as well as number of affected organs,number of patients with acute kidney injury(AKI),number of patients receiving mechanical ventilation(MV),number of patients with shock,nutritional risk screening 2002(NRS 2002)score,and length of hospital stay,and compare the differences in the above indicators between the two groups with and without sepsis and between the two groups with different clinical outcomes.Multivariate Logistic regression was used to identify independent risk factors for sepsis development and factors influencing the 28-day prognosis of sepsis patients.Receiver operating characteristic curve(ROC curve)were constructed to evaluate the predictive ability of PCT,PTX3 and APACHEⅡscore for sepsis,and the efficacy of PTX3 combined with APACHEⅡscore in predicting adverse outcomes in septic patients was assessed.Results A total of 218 patients were enrolled,comprising 101 non-sepsis cases and 117 sepsis cases.The overall 28-day mortality rate was 18.8%(41/218),while the 28-day mortality rate for sepsis patients was 29.1%(34/117).Compared with the non-sepsis group,the sepsis group was older,had a higher proportion of bedridden patients,had poorer nutritional status,and showed significantly higher numbers of affected organs,incidence of AKI,proportion of patients receiving MV,incidence of shock,levels of WBC,CRP,Lac,PCT,and PTX3,as well as critical illness scores,along with a longer length of hospital stay;all differences were statistically significant(all P<0.05).Compared with the sepsis survivor group,the non-survivor group had a higher proportion of bedridden patients,a greater number of affected organs,higher proportions of patients receiving MV and experiencing shock,poorer nutritional status,and higher levels of PTX3 and PCT as well as critical illness scores;all differences were statistically significant(all P<0.05).Multivariate Logistic regression revealed that APACHEⅡscore,PCT and PTX3 level were independent risk factors for sepsis development[odds ratios(OR)and 95%confidence interval(95%CI):1.202(1.091-1.324),1.064(1.004-1.127),and 1.362(1.223-1.515);P values were 0.000,0.035,and 0.000,respectively].After variable selection using Lasso regression,multivariate Logistic regression found that the occurrence of shock,PTX3,and APACHEⅡscore as independent predictors of 28-day mortality in sepsis patients[OR and 95%CI:4.025(1.393-11.629),1.203(1.042-1.389),1.169(1.076-1.269);P values:0.010,0.012,0.010,respectively].ROC curve analysis showed that the combination of PTX3 and APACHEⅡscore had good predictive performance for the development of sepsis and adverse 28-day outcomes[area under the curve(AUC)=0.911,0.860,sensitivity were 79.5%,85.3%,specificity were 91.1%,83.1%).Conclusions PTX3 may have the value of early identification for the development of sepsis in patients with acute infection and has a good predictive value for the 28-day prognosis of sepsis patients.Combined with APACHEⅡscore,it will further improve predictive ability.