关键词:

脓毒症, 晚期糖基化终末产物, 可溶性糖基化终末产物受体, SOFA 评分, 预测价值

Abstract:

Objective To investigate the correlation with advanced glycation end products（AGEs）and soluble receptor for advanced glycation end products（sRAGE）with sepsis⁃related organ failure assessment（SOFA） in patients with sepsis as well as the risk factors that affect the prognosis of patients with sepsis. Methods From January 2020 to May 2021，A total of 180 patients with sepsis admitted to the Intensive Care Unit of the Second Affiliated Hospital of Hainan Medical University were selected as the research objects，and the patients were divided into survival groups（n = 144）and death group（n = 36）according to the 28⁃day prognosis. The clinical data were collected，and the SOFA score，Charlson comorbidity index（CCI）were calculated within 24 hours after admission. Serum levels of procalcitonin（PCT），C⁃reactive protein（CRP），lactic acid（Lac），and plasma levels of AGEs and sRAGE were measured. The PCT，CRP，SOFA scores，and plasma AGEs and sRAGE levels of the two groups were compared. The 28⁃day mortality，and plasma AGEs and sRAGE levels in different SOFA score evaluation groups were compared. Spearman correlation analysis was used to explore the correlationship between plasma levels AGEs and sRAGE with SOFA score. Multivariate logistic regression was used to analyze the influencing factors of 28⁃day prognosis in patients with sepsis. The receiver operating characteristic（ROC）curve was used to evaluate the predic⁃ tive value of plasma AGEs，sRAGE，SOFA scores and their combination on the 28⁃day prognosis of patients with sepsis. Results Compared with the survival group，the age and incidence of diabetes was higher in the death group. The CCI score，SOFA score，serum levels of PCT and Lac，and plasma levels of AGEs and sRAGE were significantly increased（P < 0.05）. With the increase of SOFA score，the 28 ⁃ day mortality and plasma levels of AGEs and sRAGE increased significantly（P < 0.05）. Plasma levels of AGEs and sRAGE were significantly positively correlated with SOFA score（rs = 0.293，0.309，P < 0.05）. CCI score，SOFA scores，AGEs and sRAGE were the risk factors for 28⁃day mortality in patients with sepsis（P < 0.05）. The Cut⁃off values of SOFA scores，AGEs and sRAGE for predicting 28⁃day mortality in patients with sepsis were 8 points，28.21 μg/mL and 2 465.32 pg/mL，respectively. The area under ROC curve（AUC）of combined prediction of 28⁃day mortality in patients with sepsis was significantly greater than that of each marker alone（Z = 2.245，P = 0.025；Z = 2.717，P = 0.007；Z = 2.485，P = 0.013）. Conclusion Plasma levels of AGEs and sRAGE can better reflect the severity and prognosis of patients with sepsis. Plasma levels of AGEs and sRAGE combined with SOFA scores can effectively predict the 28⁃day prognosis of patients with sepsis. 

Key words:

sepsis, advanced glycation end products, soluble receptor for advanced glycation end products, SOFA scores, predictive value