Traditional Chinese Medicine Diagnosis “Yang-Xu Zheng”: Significant Prognostic Predictor for Patients with Severe Sepsis and Septic Shock

Sunny Jui-Shan Lin,Chih-Hung Chang,Yi-Chia Huang,Yi-Chang Su,Cheng-Hung Lee,Yung-Yen Cheng

doi:10.1155/2013/759748

Abstract

Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM) Zheng diagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCM Zheng diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor-α, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency of Nutrient-phase heat, and Qi-Xu and Yang-Xu Zhengs were significantly higher in nonsurvivors. The multivariate logistic regression analysis identified Yang-Xu Zheng as the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and without Yang-Xu Zheng revealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs of Yang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis “Yang-Xu Zheng” may provide a new mortality predictor for septic patients.

Highlights

Mortality of severe sepsis and septic shock remains elevated despite progress in therapy [1]
Acute Physiology and Chronic Health Evaluation (APACHE) II score was significantly higher among non-survivors
Our prospective observational results indicate (1) Yang-Xu Zheng serves as an early predictor for sepsis outcome, since patients with it show higher APACHE II scores; and (2) in cases without it, these host response cytokines are reported as significantly lower: tumor necrosis factor-α (TNF-α), IL-6, IL-8, IL-10, and IL-18

Summary

Introduction

Mortality of severe sepsis and septic shock remains elevated despite progress in therapy [1]. Diagnostic methods reliably identifying patients with a higher risk of death are urgently needed in order to provide timely treatment and improve cost-efficacy of intensive care [2]. Since reliable concepts and accurate measurements to rate mortality risk and stratify severity of septic patients are insufficient [3, 4], a classification system named PIRO was developed to stratify patients on the basis of their predisposition, the nature and extent of insult/infection, nature and magnitude of response, and degree of concomitant organ dysfunction [5, 6]. Similar diagnostic concepts exist in traditional Chinese medicine (TCM) Zheng diagnosis.

Methods

Results

Discussion

Conclusion