Persistent inflammation, immune-suppression and catabolism syndrome secondary to sepsis in elderly patients in medical intensive care unit: a retrospective study

Abstract

Objective To investigate the clinical characteristics, risk factors and prognosis of patients with persistent inflammation, immune-suppression and catabolism syndrome(PICS)secondary to sepsis in medical intensive care unit(MICU)in initial stage, in order to increase the understanding of PICS and provide the reference experience for the early screening of high-risk patients. Methods A total of 298 elderly patients diagnosed as sepsis admitted into MICU from Aug.2013 to Dec.2016 were retrospectively studied.Of them, 97 patients meeting inclusion criteria were ultimately enrolled and separated into the PICS group and the non-PICS group.General and clinical data and laboratory indexes at first day admitted into MICU were compared between the two groups.The indexes between the two groups were analyzed statistically by multivariate logistic regression analysis.The survival-time distributions were estimated by Kaplan-Meier model, and the difference in prognosis was compared between the two groups. Results Of 97 patients, 36 patients(37.1%)met the diagnosis of PICS.The acute physiological function and chronic health evaluation Ⅱ(APACHEⅡ)score had a significant difference between the two groups(27.7±5.8 vs.22.9±6.0, P 0.05). Conclusions The elderly patients with persistent inflammation, immune-suppression, and catabolism syndrome(PICS)secondary to sepsis in medical intensive care unit(MICU)show the higher levels of APACHEⅡ score and AGI grade, and lower values of platelet counts, CD4+ T cell counts and CD4+ /CD8+ ratio in initial stage.And APACHEⅡ score is an independent risk factor for PICS in elderly sepsis patients, and the optimal cut-off value of APACHEⅡ score for predicting PICS is 26.5.The prognosis for advanced stage and long term prognosis are poor.It is essential to use APACHEⅡ and so on, to timely identify and intervene PICS. Key words: Persistent inflammation, immune-suppression, and catabolism syndrome; Sepsis; Risk factor; Prognosis