Early Prediction for Persistent Inflammation-Immunosuppression Catabolism Syndrome in Surgical Sepsis Patients

Figures & data

Table 1 Characteristics of Patients

	N=169
Age (Median IQR)	65 (54–76)
Male, n (%)	122 (72.19%)
BMI (Median IQR)	22.85 (19.46–25.08)
Surgery, n (%)
Gastrointestinal
Tumor	78 (46.15%)
ERCP	8 (4.73%)
Emergence	60 (35.5%)
Orthopedics	5 (2.96%)
Urinary	5 (2.96%)
Neurology	4 (2.36%)
Lung	4 (2.36%)
Primary sepsis diagnosis
Intra-abdominal	96 (56%)
Lung	16 (11.83%)
Blood	9 (5.32%)
Urinary	2 (1.18%)
Surgical site	2 (1.18%)
Intra-abdominal + Blood	18 (10.64%)
Lung + Blood	2 (1.18%)
Intra-abdominal + Lung	4 (2.36%)
Lung + Blood + Intra-abdominal	3 (1.78%)
Other	13 (7.69%)
Organ dysfunction, n (%)
Renal	70 (41.42%)
Respiratory	103 (60.95%)
Circulation	55 (32.54%)
Coagulation	54 (31.95%)
Chronic comorbidity
Neurologic	17 (10.06%)
Chronic Heart Failure	14 (8.28%)
Tumor	67 (39.64%)
Respiratory	9 (5.32%)
Hypertension	75 (44.37%)
Cirrhosis	7 (4.14%)
Chronic Kidney Disease	9 (5.32%)
Others	8 (4.73%)
Sepsis severity score
APACHE II, median (IQR)	20 (15–27)
CCI, median (IQR)	2 (1–3)
SOFA, median (IQR)	10 (6–13)

Table 2 Propensity Score Matching and Outcomes for Patients

	Before Propensity Score Matching			After Propensity Score Matching
	PICS	Non-PICS	P-value	PICS	Non-PICS	P-value
	N=47	N=122		n=34	n=55
CCI	4 (2–5)	2 (1–3)	<0.001^a	3.17±1.4	2.8±1.6	0.937^b
SOFA	11 (9–15)	9 (6–12)	0.003^a	10.97±4.33	10.87±4.53	0.683^b
BMI	22.2 (19.5–26.2)	23.0 (20.2–25.0)	0.994^a	23.08±4.78	22.91±4.01	0.147^b
Age	67 (56–78)	65 (51–76)	0.413^a	65±16	65±15	0.641^b
APACHE II	22 (17–28)	19.5 (15–25)	0.025^a	22.02±7.04	21.91±8.64	0.308^b
Male	31 (66%)	91 (74.6%)	0.338^a	21 (67.44%)	39 (70.90)	0.373^b
Outcomes
ICU length of stay (days) (IQR)	29 (20–55)^a	12 (8–26)	<0.005^a	29 (20–55)	11 (7–27)	<0.001^a
Hospital length of stay (days) (IQR)	55 (29–77)^a	43 (23–69)	0.089^a	43 (25–76)	54 (26–81)	0.387^a
Mortality, n (%)
ICU mortality	17 (36.2%)	10 (8.2%)	<0.001^c	11 (32.40%)	8 (12.4)	0.046^c
Mortality 28 days	5 (10.6%)	2 (1.6%)	0.024^c	4 (11.76%)	2 (3.63%)	0.067^c
Mortality 90 days	18 (38.3%)	8 (6.6%)	<0.005^c	11 (32.40%)	5 (9.1%)	0.006^c
ICU-acquired infection	18 (38.29%)	14 (11.47%)	<0.001^c	15 (44.1%)	7 (12.7%)	0.001^c
Bacteria	15 (31.91%)	14 (11.47%)	0.003^c	12 (35.3%)	7 (12.7%)	0.012^c
Fungi	3 (6.38%)	0 (0.00%)	0.005^c	3 (8.8%)	0 (0.00)	0.102^c

Notes: ^aMann–Whitney test (U-test). ^bStudent Test (t test). ^cChi-square test.

Figure 1 The Kaplan-Meier survival curve for mortality within 90 days. Log-rank p < 0.01: PICS group had a lower survival rate than non-PICS group.

Abbreviation: PICS, persistent inflammation-immunosuppression and catabolism syndrome.

Table 3 Laboratory Parameters of Patients

	PICS (n=47)	Non-PICS (n=122)	P-value
Day 1
CRP (mg/l)	95.6 (68.3–170.8)	120 (49.0–208.3)	0.426
PCT (ng/dl)	5.6 (1.5–23.7)	2.3 (0.78–17.37)	0.118
Neutrophil count (×10^9/L)	10.1 (6.7–15.1)	11.0 (6.3–15.8)	0.920
Lymphocyte count (×10^9/L)	0.6 (0.4–0.8)	0.7 (0.4–1.1)	0.040*
NLR	17.6 (12.5–26.6)	15.7 (7.4–24.0)	0.159
Albumin (g/L)	25.0 (22.0–30.0)	28 (24.0–34.0)	0.035*
Pre-albumin (g/L)	76 (56–114)	85.0 (50.5–118.0)	0.783
Day 3	n=47	n=122
CRP (mg/L)	138 (99.1–222.8)	131 (73.2–195.6)	0.370
PCT (ng/dl)	4.8 (1.4–16.7)	2.4 (0.6–17.6)	0.101
Neutrophil count (×10^9/L)	10.3 (7.7–15.0)	9.2 (5.5–13.6)	0.273
Lymphocyte count (×10^9/L)	0.6 (0.4–0.8)	0.8 (0.5–1.2)	0.002**
NLR	16.9 (10.3–26.4)	10.5 (7.2–17.9)	0.001**
Albumin (g/L)	30.0 (26.5–32.0)	29.0 (27.0–32.0)	0.839
Pre-albumin (g/L)	67.0 (48.0–101.0)	81.0 (57.0–113.8)	0.107

Notes: All with Mann–Whitney (U-test). *p<0.05. **p<0.01.

Table 4 The Result of Logistic Regression and ROC Curve

		P-value		OR (95% CI)
Univariate
APACHE II		0.027		1.050 (1.005, 1.09)
Lymphocyte day 1		0.025		0.407 (0.186, 0.894)
Lymphocyte day 3		0.01		0.295 (0.116, 0.752)
Albumin day 1		0.118		1.040 (0.990, 1.092)
NLR day 3		0.38		1.005 (0.993, 1.017)
SOFA Score		0.004		1.126 (1.038, 1.221)
CCI		<0.001		1.833 (1.466, 2.290)
Multivariate
Albumin day 1		0.013		1.081 (1.016–1.149)
Lymphocyte day 3		0.016		0.222 (0.64 0.757)
SOFA Score		0.032		1.118 (1.015–1.230)
CCI		<0.001		1.911 (1.494–2.443)
ROC curve
	AUC	95% CI	P-value	Regression Coefficient
CCI	0.770	0.688–0.853	<0.001	0.616
SOFA	0.649	0.560–0.738	0.003	0.115
Albumin day 1	0.605	0.508–0.701	0.035	0.076
Lymphocyte day 3	0.348	0.260–0.436	0.002	−1.701
Combined predictor	0.838	0.774–0.901	<0.001