Utility of admission platelet count to predict prognosis and determine illness severity in acute cholangitis.

Objective To study the predictive value of acute gastrointestinal injury (AGI) grading system introduced into Sequential Organ Failure Assessment (SOFA) score in patients with severe acute pancreatitis (SAP) in order to provide a reliable clinical tool for the evaluation of prognosis of SAP. Methods Patients with acute pancreatitis admitted to ICU from July 2012 to July 2014 were enrolled for study. The criteria of exclusion were the age below 18 years old, pregnancy, or patients without consent to the treatment. A total of 63 patients with 37 males and 26 females aged (47 ±15.3) years were included. The data of their acute physiology and chronic health evaluation (APACHE) Ⅱ score, the highest SOFA score and AGI grade within the first week, and the 28-day mortality rate were collected. Patients without AGI were defined as zero point, and AGI grade I -IV were defined as 1-4 points. The receiver operating characteristic curve (ROC) was used to evaluate the value of APACHEⅡ score, SOFA score, and SOFA + AGI score in predicting the prognosis of SAP. The areas under ROC curve (AUC) of the APACHEⅡ score, SOFA score, and SOFA +AGI score were compared with MedCalc software, and P value less than 0.01 was considered to be statistical significance. Results (1) The 28-day mortality of the 63 patients with SAP was 20.6% (13/63), in which 50 patients in the survival group, 13 patients in the death group. The APACHEⅡ scores of two groups were (15.62 ± 4.33 vs. 12.10 ± 3.74, P =0.0048), the SOFA scores were (14.77 ± 3.09 vs. 9.24 ± 2.88, P <0.01), and the SOFA +AGI scores were (18.77 ± 3.09 vs. 10.74 ± 3.17, P <0.01). (2) The AUC of APACHEⅡ score was 0.748 ± 0.084 (95% CI: 0.622-0.849), the AUC of SOFA score was 0.902 ± 0.059 (95% CI: 0.801-0.962), and the AUC of SOFA +AGI score was 0.963 ± 0.037 (95% CI, 0.882-0.994) ; There was no significant difference in AUC between APACHEⅡ score and SOFA score (P =0.10) , and there was statistical significance between the AUC of APACHEⅡ score and that of SOFA +AGI score (P =0.013) , and the difference in AUC between SOFA score and SOFA +AGI score was statistically significant (P =0.008). The Youden index and the positive likelihood ratio of SOFA +AGI score system were the greatest to be 0.863 and 15.38, respectively. Conclusions SOFA scoring system has better predictive value in patients with SAP when AGI grading system was introduced into it. Key words: Acute gastrointestinal injury grading system; APACHEⅡ score; SOFA score; Severe acute pancreatitis; Prognosis

To explore the predictive efficacy of prothrombin time (PT) with regarding for the severity and prognosis of septic patients, along with comparing with other routine coagulation parameters. A retrospective analysis was conducted. The clinical data of 302 septic patients who were admitted to the intensive care unit (ICU) of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 1 to December 31 in 2019 were enrolled. Demographic and basic clinical data were collected. Laboratory data, including PT, activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer, fibrin (fibrinogen) degradation product (FDP), antithrombin (AT), platelet count (PLT) at ICU admission were recorded, and sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score within 24 hours of admission to ICU were also collected. What's more, some major clinical events, such as septic shock, disseminated intravascular coagulation (DIC), etc. during ICU stay were also monitored. A follow-up 28 days observation of prognosis was performed. The patients were divided into the septic shock group and the non-septic shock group according to the occurrence of septic shock, and they were divided into the survival group and the non-survival group according to the 28-day prognosis. The differences in terms of above parameters between each two groups were compared. Spearman correlation method was used to analyze the correlation between routine coagulation parameters and SOFA score or APACHE II score. Receiver operator characteristic curve (ROC curve) was plotted to determine the predictive efficacy of each routine coagulation parameter with regarding to predict septic shock and 28-day mortality. Based on the cut-off value of PT, the septic patients were divided into two risk stratifications, and then the major clinical and end point outcome were compared. Kaplan-Meier survival curve analysis was applied to investigate the difference of the 28-day cumulated survival rate based on the different risk stratifications of PT level. Finally, multivariate Logistic regression analysis was used to explore whether prolonged PT level was an independent risk factor for septic shock and 28-day mortality. The 302 patients were all enrolled, including 120 patients with septic shock and 182 patients without. Seventy-five patients died within 28 days, while 227 survived. Comparing with the non-septic shock group or the survival group, the septic shock group or the non-survival group patients both had longer PT, APTT and TT, higher D-dimer, FDP and lower PLT, FIB and AT. Correlation analysis revealed that PT and PLT were better correlated with SOFA score (r values were 0.503 and -0.524, both P < 0.01), and PT was better correlated with APACHE II score (r = 0.407, P < 0.01). ROC curve analysis showed that PT had the most powerful predictive efficacy for septic shock and 28-day mortality. The area under the ROC curve (AUC) and 95% confidence interval (95%CI) were 0.831 (0.783-0.879) and 0.739 (0.674-0.805), respectively. The cut-off value were 16.8 s and 16.3 s, respectively, with the sensitivity of 64.2%, 72.0% and the specificity of 89.0%, 70.9%, respectively. Risk stratification based on PT level revealed that the patients with PT > 16.5 s (n = 103) had higher rate of 28-day mortality, incidence of septic shock and DIC, and score of SOFA and APACHE II comparing to those with PT ≤ 16.5 s (n = 199). Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate was significantly lower in the patients with PT > 16.5 s than those with PT ≤ 16.5 s (52.43% vs. 86.93%; Log-Rank test: χ2 = 49.428, P < 0.001). Multivariate Logistic regression analysis revealed that PT > 16.5 s was an independent risk factor both for septic shock and 28-day mortality [model 1 (enrolled SOFA score): odds ratio (OR) and 95%CI were 6.003 (3.040-11.855), 4.842 (2.114-11.089); model 2 (enrolled APACHE II score): OR and 95%CI were 7.675 (4.007-14.702), 5.160 (2.258-11.793)]. Compared with other routine coagulation parameters, PT has the potential best predictive value for evaluating the severity of sepsis and the prognosis. When a patient is diagnosed with sepsis and has a result of PT longer than 16.5 s at ICU admission, the patient may have a higher risk of progression to septic shock and short-term death.

Purpose: This retrospective analysis aimed to elucidate the key factors influencing survival outcomes in patients diagnosed with lymphoma and admitted to an Intensive Care Unit (ICU). Materials and Methods: The study cohort comprised individuals aged 18 or older diagnosed with lymphoma and admitted to the ICU between November 2015 and February 2023. Data were collected on patients' demographic characteristics, primary hematological diagnoses, reasons for ICU admission, laboratory parameters, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, clinical trajectory, and 28-day mortality rates. Patients were stratified into two categories based on their mortality outcomes: Survivors and non-survivors. Results: A total of 165 patients were included in the study, with a mean age of 52.41 ± 17.99 years; 63% were male. Table 1 summarizes the demographic characteristics, clinical trajectories, and 28-day mortality rates. The APACHE II and SOFA scores of the patients were 34 (7–53) and 12 (10–14), respectively. The predominant reasons for ICU admission were sepsis (58.2%) and acute respiratory failure (57.6%). Vasopressor necessity prior to and during ICU stay was 23.6% and 92.4%, respectively. During ICU monitoring, thrombocytopenia, and acute kidney injury (AKI) were observed in 77.6% and 66.4% of patients, respectively; 10% required renal replacement therapy. The 28-day mortality rate was 84.8%. Kaplan-Meier analysis revealed that patients with a SOFA score ≥ 9 had a significantly reduced survival time of 4.5 ± 0.4 days compared to those with lower SOFA scores (14.3 ± 2.6 days). Patients with AKI and those requiring invasive mechanical ventilation (IMV) exhibited reduced survival times of 4.7 ± 0.5 days and 5.6 ± 0.5 days, respectively. Elevated SOFA scores (HR 2.355, 95% CI 1.485–3.734), presence of AKI (HR 1.511, 95% CI 1.055–2.163), and the need for IMV (HR 5.721, 95% CI 1.377–23.770) were significantly correlated with increased 28-day mortality. Receiver Operating Characteristic (ROC) curve analysis identified the optimal SOFA cut-off point for predicting 28-day mortality as nine, with an Area Under the Curve (AUC) of 0.897, sensitivity 83.6% and specificity 92%. Conclusions: The findings of this study underscore the elevated mortality rates among lymphoma patients admitted to the ICU. Our data suggest that several factors serve as significant predictors of 28-day mortality in this patient population. Specifically, elevated APACHE II scores, SOFA scores, the presence of AKI, and the requirement for IMV emerged as crucial indicators associated with adverse survival outcomes. Consequently, these factors warrant meticulous monitoring and could inform targeted interventions to improve survival rates among lymphoma patients in critical care settings.

BackgroundSepsis is a state of life-threatening organ dysfunction caused by a dysregulated host response to infection, leading to consecutive organ failure and lethal outcome. The purpose of this study is to assess the value of the combined use of plasma high-density lipoprotein 2b (HDL2b) level and Sequential Organ Failure Assessment (SOFA) score in predicting short-term mortality from sepsis.Materials and methodsA prospective, observational study was conducted in patients with sepsis and non-septic controls admitted to three intensive care units (ICUs) from January 2020 to December 2021. SOFA scores were recorded on the first day after admission. Blood samples were collected from each enrolled patient and the levels of HDL2b were analyzed using microfluidic chip technology. Receiver-operator characteristic curve (ROC) analyses were conducted to determine the values of plasma HDL2b level, SOFA score and the combined HDL2b levels and SOFA score (HDL2b + SOFA) in predicting the prognosis of mortality, respectively. The primary endpoint was 28-day mortality and the secondary outcome was total in-hospital mortality.ResultsCompared to non-septic controls, patients with sepsis had lower HDL2b levels (10.95% [8.95, 12.96] vs. 23.78% [14.53, 29.16], p < 0.001). Among sepsis patients, the levels of HDL2b of non-survivors were lower than those of survivors (6.74% [4.63, 8.08] vs. 11.78 [7.20, 13.40], p = 0.002). Moreover, our data also indicated that patients with higher HDL2b + SOFA scores shown higher rates of 28-day and total in-hospital mortality. The areas under the ROC curves for predicting 28-day mortality were 0.755 for HDL2b, 0.782 for SOFA, and 0.806 for HDL2b + SOFA. Multivariate analyses indicated that HDL2b + SOFA (Odd Ratio: 1.321 (95% Confidence Interval: 1.028–1.698), p = 0.029) was potential predictors of 28-day mortality.ConclusionsThe HDL2b + SOFA composite score was a reliable predictor of 28-day and in-hospital mortality in sepsis patients, showing better discriminatory ability than SOFA alone.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12879-025-12147-z.

Background and Aims Recently, more and more attention has been paid to the predictive value of neutrophil to lymphocyte ratio (NLR) in various diseases. As a novel marker for inflammatory response, NLR has been proved to be useful for the diagnosis and prognosis evaluation of inflammatory diseases such as tumor, diabetes, atherosclerosis and other disease. It is well known that inflammatory response plays an important role in the occurrence and development of AKI. Previous studies have shown that NLR has a great value in the diagnosis of AKI, but its value in the prognosis evaluation in AKI patients, especially in critical ill patients with AKI, remains unclear. This study aimed at investigating the predictive value of neutrophil-lymphocyte ratio (NLR) on the risk of 90-day mortality in critically ill patients with acute kidney injury (AKI), so as to provide a simple, feasible, and valuable tool for the prognosis assessment of such patients. Method The data of 802 critically ill patients with AKI admitted to the intensive care unit of the First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2019 were retrospectively analyzed. According to the initial NLR level at admission, they were divided into a low NLR group (NLR≤9) and a high NLR group (NLR&amp;gt;9). Differences in comorbidities, the initial Sequential Organ Failure Assessment (SOFA) score, white blood cell (WBC), neutrophil percentage (Neu%), hemoglobin (Hb), platelet (PLT), lactic acid (Lac), pH, blood glucose (Glu), creatine kinase (CK), and all-cause mortality at 90-day were compared between groups. Binary Logistic regression model was used to analyze the risk factors for 90-day mortality in critically ill patients with AKI, and the receiver operating characteristic (ROC) curve was computed to evaluate the predictive value of NLR for the risk of 90-day mortality in such patients. Results There were no statistically significant differences in age, sex, and Glu between the two groups. The SOFA score, WBC, Hb, Plt, Lac, CK, SC, BUN and NEU％of patients in the high NLR group were higher than those in the low NLR group, while the BMI and pH value was lower in the high NLR group than that in the low NLR group. The 90-day mortality rate was significantly higher in the high NLR group than that in the low NLR group (36.2% vs 16%, P &amp;lt; 0.001). Binary Logistic regression showed that NLR was an independent risk factor for 90-day mortality in critically ill patients with AKI (OR＝2.402, 95% CI:1.633-3.533,ï¼°＜0.001), even after adjusting for age, gender, BMI, comorbidities, SOFA score, and AKI stages. The area under the ROC curve (AUC) of NLR predicting 90-day mortality was 0.613 with a highest prognostic cut-off point of 8. The sensitivity was 65.77%, and the specificity was 54.78%. Conclusion NLR has a predictive value on risk of the 90-day mortality in critically ill patients with AKI. As a simple and easily available clinical indicator, NLR could be applied as a valuable tool in guiding the initial treatment of such patients.

To explore the early predictors and their predicting value of 28-day mortality in sepsis patients and to investigate the possible causes of death. 127 sepsis patients were included, including 79 cases in the survival group and 48 cases in the death group. The results of all patients on admission were recorded. After screening the risk factors of 28-day mortality, the receiver operating characteristic curve (ROC) was used to determine their predictive value for the 28-day mortality rate on admission, and the Kaplan-Meier curve was drawn to compare the 28-day mortality rate between groups. Finally, patients with cytokine and lymphocyte subsets results were included for investigating the possible causes of death through correlation analysis. APACHE II (acute physiology and chronic health evaluation II), SOFA (Sequential Organ Failure Assessment) and red blood cell distribution width (RDW) were the risk factors for 28-day mortality in sepsis patients (OR: 1.130 vs.1.160 vs.1.530, P < 0.05). The area under the curve (AUC), sensitivity and specificity of APACHE II, SOFA and RDW in predicting the mortality rate at 28 days after admission in sepsis patients were 0.763 vs 0.806 vs 0.723, 79.2% vs 68.8% vs 75.0%, 65.8% vs 89.9% vs 68.4%. The combined predicted AUC was 0.873, the sensitivity was 89.6%, and the specificity was 82.3%. The Kaplan-Meier survival curve showed that the 28-day mortality rates of sepsis patients with APACHE II≥18.5, SOFA≥11.5 and RDW≥13.8 were 58.5%, 80.5% and 59.0%, respectively. In the death group, APACHE II was positively correlated with SOFA, IL-2, and IL-10, and RDW was positively correlated with PLT, TNF-α, CD3+ lymphocyte count, and CD8+ lymphocyte count. Sepsis patients with high APACHE II, SOFA and RDW levels at admission have an increased 28-day mortality rate. The elevation of these indicators in dead patients are related to immune dysfunction.

Aims. We sought to determine outcome and evaluate performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores upon admission in predicting 30-day mortality of end-stage renal disease (ESRD) patients admitted in ICU. Methods. This prospective observational cohort study examined 73 consecutive ESRD patients admitted in an ICU of a tertiary care institute over 15 months. Primary outcome measure was 30-day mortality. Data on patient characteristics, reason for ICU admission, cause of ESRD, mode of renal replacement, and use of mechanical ventilation (MV) or inotropes were recorded. The APACHE 2 and SOFA scores were calculated based on admission characteristics. Results. First-day median APACHE II, SOFA, and APACHE II-predicted hospital mortality rates were 26 (14–49), 7 (4–17), and 56.9% (18.6–97.4%), respectively. Observed ICU and 30-day mortality rates were 27.4%, and 41.1%, respectively. During the ICU course, MV and inotropic support was required in 27 (37%) and 23 (35.1%) patients, respectively. Need for MV (p < 0.001) and inotropic support (p < 0.001) were predictors of 30-day mortality in univariate analysis. Area under receiver operating characteristic curve for APACHE II in predicting 30-day mortality was 0.86 (95% CI, 0.76–0.93) compared with 0.92 (95% CI, 0.83–0.97) for SOFA score (p = 0.16). Conclusions. Outcome of ESRD patients admitted to ICU is poor, especially if they require other organ support. APACHE II and SOFA scores perform well as predictors of 30-day mortality.

Decision letter: An open label trial of anakinra to prevent respiratory failure in COVID-19

Purpose To analyze the clinical significance of the sequential organ failure assessment (SOFA) score in the diagnosis, treatment, and prognostic assessment of sepsis. Methods 140 patients with sepsis from January 2020 to January 2021 were selected as the observation group, and 40 healthy people were selected as the control group. The observation group was divided into mild group, severe group, and septic shock group by single blind grouping according to the condition of the disease, and they were also divided into survival group and death group according to the prognosis. Collect the fasting venous blood of the subjects in each group in the morning, compare the levels of total bilirubin (TBIL), blood creatinine (CR), and platelet count (PLT) in each group, and record and compare the patients' respiratory system oxygen partial pressure/inhaled oxygen concentration (po2/fio2), acute physiology and chronic health scoring system II (APACHE II), sequential organ failure assessment (sofa) score, q-SOFA score, and △SOFA score; Pearson analysis was used to analyze the correlation between SOFA score and other indicators; multivariate logistic regression was used to analyze the prognostic risk factors of patients with sepsis; receiver-operating characteristic curve (ROC) was used to analyze the value of SOFA score alone and in combination in the diagnosis, condition, and prognosis of sepsis. Results There were significant differences in Apache II score, SOFA score, q-SOFA score map, po2/fio2, PLT, GCS, TBIL, and serum creatinine (SCR) between the control group and the observation group (P < 0.05). There were significant differences in Apache II score, SOFA score, q-SOFA score, mean arterial pressure (map) po2/fio2, PLT, Glasgow Coma Score (GCS), TBIL, SCR, and △SOFA score among patients in mild, severe, and septic shock groups (P < 0.05). There were significant differences in age, Apache II score, SOFA score, q-SOFA score, map, po2/fio2, PLT, GCS, TBIL, SCR, and △SOFA score between survival group and death group (P < 0.05). SOFA score and q-SOFA score were significantly positively correlated with TBIL and SCR and significantly negatively correlated with po2/fio2 and PLT; △SOFA score was significantly negatively correlated with TBIL and SCR and significantly positively correlated with map, po2/fio2, PLT, and GCS. Apache II score, SOFA score, and q-SOFA score were independent risk factors for sepsis patients, and △SOFA score, po2/fio2, and GCS score were protective factors (P < 0.05). ROC curve analysis showed that the AUC of sepsis combined with SOFA score and q-SOFA score was 0.880; the AUC of sepsis assessed by SOFA score, q-SOFA score, and △SOFA score was 0.929; the AUC of sepsis prognosis assessed by SOFA score, q-SOFA score, and △SOFA score was 0.900. Conclusion SOFA score, q-SOFA score, and △SOFA score were abnormally expressed in patients with sepsis and were risk factors for the severity of the patient's condition and prognosis. The SOFA score, q-SOFA score, and △SOFA score were risk factors for the severity and prognosis of patients with sepsis and had some value in diagnosing sepsis and assessing the condition and prognosis, of which the combined value of the three was higher.

Predicting Surgical Risk in Patients With Cirrhosis: From Art to Science

This study aimed to investigate the clinical manifestations and risk factors for 28-day mortality in patients with stress cardiomyopathy (SC) in the intensive care unit (ICU). This retrospective study was carried out from April 2015 to March 2021. Fifty-five patients in the ICU were diagnosed with SC. Two patients were excluded due to a history of atrial fibrillation (AF), and 53 patients were enrolled in the study. Baseline demographics and clinical characteristics were collected, and the 28-day mortality rate was calculated. Multivariate and univariate logistic regression analyses were used to determine the significant predictors of 28-day mortality. Of the 53 patients, almost half (47.17%) were male. The most common stress trigger was sepsis (37.74%). Due to sedation and tracheal intubation, 49.06% of SC patients were unable to express their symptoms, and only 3.77% of patients presented with chest pain. The proportion of patients with complications of systolic heart failure and cardiogenic shock was 77.36% and 39.62%, respectively. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score when patients were admitted into the ICU was 21.17±8.41, and the Sequential Organ Failure Assessment (SOFA) score at diagnosis of SC was 9.30±4.56. Eighteen (33.96%) SC patients had new-onset AF while in the ICU. The 28-day mortality rate in patients with SC in the ICU was 64.15%. Univariate analysis found that 5 variables [SOFA score at diagnosis of SC, estimated glomerular filtration rate (eGFR) <60 mL/min at diagnosis of SC, maximum norepinephrine dose, new-onset AF, and systolic heart failure] were correlated with 28-day mortality in patients with SC in the ICU. Multivariate logistic regression analysis suggested SOFA score at diagnosis of SC (P=0.042), eGFR <60 mL/min at diagnosis of SC (P=0.027), and new-onset AF (P=0.043) as independent predictors of 28-day mortality. Male patients with SC were relatively more common in the ICU than in the cardiology unit. Sepsis was a common stress trigger. The 28-day mortality rate was very high. The SOFA score and eGFR <60 mL/min at diagnosis of SC and new-onset AF may have influenced patients' short-term prognosis.

BackgroundThe Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score.MethodsWe developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock.ResultsWe identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p < 0.001), test set (0.716 vs 0.638), and all other cohorts (0.648 vs 0.557, 0.674 vs 0.589). Calibration was modest. In the suspected infection cohort, the modified model classified more patients to sepsis (66.0 vs 62.5%) and identified more patients at risk of septic mortality than the SOFA score (92.6 vs 89.5%).ConclusionsAmong ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.

Identification and validation of prognostic factors in patients with COVID-19: A retrospective study based on artificial intelligence algorithms

To investigate the clinical value of serum endocan and procalcitonin (PCT) in early diagnosis and prognosis evaluation of sepsis. The patients with systemic inflammatory response syndrome (SIRS, n = 26) and sepsis (n = 78) admitted to intensive care unit (ICU) of the Third Hospital of Hebei Medical University from December 2014 to December 2016 were enrolled. According to the severity of disease, the sepsis patients were divided into general sepsis group (n = 20), severe sepsis group (n = 24), and septic shock group (n = 34). The cases were divided into survival group (n = 55) and non-survival group (n = 23) according to 28-day mortality. The serum endocan, PCT, acute physiology and chronic health evaluation II (APACHEII) score, and sequential organ failure assessment (SOFA) score were recorded when the patients were admitted into ICU. The differences in endocan, PCT, APACHEII, SOFA score between SIRS and sepsis groups and within sepsis subgroups were compared. Spearman correlation analysis was used to analyze the correlation between the indexes of sepsis patients. Receiver operation characteristic curve (ROC) was used to evaluate the value of endocan and PCT for the diagnosis and prognosis of sepsis. (1) Serum endocan, PCT, APACHEII, SOFA score and 28-day mortality in the sepsis group were significantly higher than those in the SIRS group [endocan (μg/L): 4.28 (10.64) vs. 1.03 (0.69), PCT (μg/L): 3.94 (10.75) vs. 0.43 (0.39), APACHEII: 18.81±9.17 vs. 9.35±3.78, SOFA: 9.00 (7.20) vs. 4.50 (1.50), 28-day mortality: 29.49% vs. 11.54%, all P < 0.01]. The area under the ROC curve (AUC) of endocan, PCT, APACHEII, SOFA score for sepsis diagnosis were 0.887, 0.842, 0.822, 0.835, respectively. When the cut-off value of endocan was 1.26 μg/L, the sepsis diagnostic sensitivity was 87.2% and specificity was 81.8%. When the cut-off value of PCT was 0.75 μg/L, the sepsis diagnostic sensitivity was 85.9% and specificity was 81.8%. (2) With the severity of the disease increased, the index showed an increasing trend in patients with sepsis. Serum endocan, PCT, APACHEII, SOFA score and 28-day mortality in septic shock group were significantly higher than those in severe sepsis group or general sepsis group [endocan (μg/L): 13.02 (6.70) vs. 3.33 (3.05), 1.60 (0.98); PCT (μg/L): 8.10 (17.68) vs. 5.47 (8.92), 1.57 (2.78); APACHEII: 25.00 (9.50) vs. 18.00 (9.00), 9.50 (5.75); SOFA: 13.00 (4.50) vs. 8.00 (3.00), 5.00 (3.50); 28-day mortality: 52.94% vs. 20.83%, 0%; all P < 0.01]. There was a significantly positive correlation between endocan, PCT, APACHEII, SOFA, indicating that the endocan and PCT can be used to assess the severity of sepsis. (3) Serum endocan, PCT, APACHEII and SOFA score in non-survival group were significantly higher than those in the survival group [endocan (μg/L): 15.05 (9.23) vs. 2.32 (4.81), PCT (μg/L): 18.40 (16.99) vs. 3.10 (6.67), APACHEII: 28.13±7.56 vs. 14.91±6.64, SOFA: 14.70±3.65 vs. 7.38±3.26, all P < 0.01]. The AUC of endocan, PCT, APACHEII, SOFA score for the prediction of non-survival sepsis were 0.915, 0.763, 0.899, 0.930. When the cut-off value of endocan was 4.37 μg/L, the septic death prediction sensitivity was 95.7% and specificity was 70.9%. When the cut-off value of PCT was 7.68 μg/L, the septic death prediction sensitivity was 65.2% and specificity was 78.2%. Serum endocan is more clinically valuable than PCT in early diagnosis and prognosis assessment of sepsis.

Background:Risk assessment with prognostic scoring, though important, is scarcely studied in emergency surgical patients with COVID-19 infection.Methods and Material:We conducted a retrospective cohort study on adult emergency surgical patients with COVID-19 infection in our institute from 1 May 2020 to 31 October 2021 to find the 30-day postoperative mortality and predictive accuracy of prognostic scores. We assessed the demographic data, prognostic risk scores (American Society of Anesthesiologists-Physical Classification (ASA-PS), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores), surgical and anesthetic factors. We assessed the postoperative morbidity using the Clavien-Dindo scale and recorded the 30-day mortality. Correlation of prognostic scores and mortality was evaluated using Univariate Cox proportional hazards regression, receiver operating characteristic curve (ROC), Youden's index and Hosmer- Lemeshow goodness of fit model.Results:Emergency surgery was performed in 67 COVID-19 patients with postoperative complication and 30-day mortality rate of 33% and 19%, respectively. A positive qSOFA and ASAPS IIIE/IVE had a 9.03- and 12.7-times higher risk of mortality compared to a negative qSOFA and ASA-PS IE/IIE (P < 0.001), respectively. Every unit increase of SOFA, POSSUM and P-POSSUM scores was associated with a 50%, 18% and 17% higher risk of mortality, respectively. SOFA, POSSUM and P-POSSUM AUCROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85 and 0.86, respectively).Conclusions:SOFA score has a higher sensitivity to predict 30-day postoperative mortality as compared to POSSUM and P-POSSUM. However, in absence of a control group of non-COVID-19 patients, actual risk attributable to COVID-19 infection could not be determined.