Prognostic value of serum trace elements Copper and Zinc levels in sepsis patients

Abstract

To analyze the prognostic value of serum trace elements Copper and Zinc in sepsis patients. A retrospective case-control study was conducted to collect the clinical data of sepsis patients in Tongde Hospital of Zhejiang Province from January 2016 to December 2019. The patients were divided into death group and survival group according to 28-day outcome. The differences of general demographic data, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), whole blood Copper, whole blood Zinc and Copper/Zinc ratio were analyzed and compared between the two groups. Receiver operating characteristic curve (ROC) and discriminant analysis were used to analyze the date with statistical significance, and the test efficiency of each risk factor was evaluated; according to the results of ROC analysis, a discriminant function was constructed to analyze the consistency between the predicted value and the real value. A total of 86 patients were enrolled, including 30 in the death group and 56 in the survival group. Compared with the survival group, the patients in death group were older (years old: 70.8±12.9 vs. 65.4±11.1), APACHE II score, SOFA score, whole blood Copper (μmol/L), Copper/Zinc ratio were higher (26.8±5.9 vs. 19.5±6.7, 14.0±3.6 vs. 7.4±4.2, 17.2±2.2 vs. 15.0±1.5, 0.24±0.05 vs. 0.18±0.03), whole blood Zinc level was lower (μmol/L: 71.2±12.0 vs. 87.7±11.3), and the differences were statistically significant (all P < 0.001). ROC curve analysis showed that APACHE II score, SOFA score, whole blood Copper, whole blood Zinc and Copper/Zinc ratio had predictive values for the prognosis of sepsis patients (all P < 0.001). The area under ROC curve (AUC) was 0.788, 0.879, 0.802, 0.869 and 0.873, 95% confidence interval (95%CI) was 0.691-0.886, 0.806-0.951, 0.686-0.918, 0.780-0.957 and 0.780-0.966, the cut-off values were 23.500, 11.500, 16.500, 79.400 and 0.195, the sensitivity was 70.0%, 76.7%, 73.3%, 83.9% and 90.0%, the specificity was 73.2%, 78.6%, 85.7%, 83.3% and 76.8%, the positive predictive values were 58.3%, 65.7%, 72.4%, 73.5% and 67.5%, and the negative predictive values were 82.0%, 86.3%, 84.2%, 90.4% and 93.5%, respectively. Five significant prognostic factors were combined forecasting analyzed, the AUC was increased to 0.941, the cut-off value was 2.500, the sensitivity was 83.3%, the specificity was 91.1%, P < 0.001. The coincidence rate between the prediction results and the actual outcome was 88.4% (76/86), and the consistency evaluation Kappa value was 0.744 (P < 0.001). APACHE II score, SOFA score, whole blood Copper, whole blood Zinc, Copper/Zinc ratio have good predictive value for the outcome of sepsis patients, and combined detection has more predictive value.