Relationship between charlson comorbidity index,arterial blood ammonia,Toll-like receptor 4 lev-el and the condition of patients with severe multiple injuries combined with sepsis and its predictive value of death risk
Objective To explore the relationship between Charlson's weighted index of comorbidities(CCI)index,arterial blood ammonia,Toll-like receptor 4(TLR4)and severe multiple injuries combined with sepsis and its predictive value of death risk.Methods A total of 90 patients with severe multiple injuries in our hospital from December 2017 to December 2019 were selected,and they were divided into 55 patients in the study group(30 patients in the simple sepsis group and 25 patients in the septic shock group)and 35 patients in the control group(simple infection)according to whether they were combined with sepsis.According to 28 d patients'survival,the study group was further divided into survival group(41 patients)and death group(14 patients).General clinical data of all patients were collected and grouped for comparison.The predictive value of CCI index,arterial blood ammonia,and TLR4 level on the risk of death was analyzed using the receiver operating characteristics(ROC)curves;the Kaplan-Meier survival curves were drawn for the survival analysis.Results CCI index,arterial blood ammonia and TLR4 levels were sequentially decreased in patients in septic shock group,simple sepsis group and control group(P＜0.05).Spearman correlation analysis showed that CCI index,arterial blood ammonia and TLR4 levels were positively correlated with the condition of severe multiple injuries combined with sepsis(P＜0.05).Cox regression analysis showed that CCI index,arterial blood ammonia and TLR4 were all independent risk factors for death in patients with severe multiple injuries combined with sepsis(P＜0.05);the area under the ROC curve(AUC)of CCI,arterial blood ammonia and TLR4 combined to predict the risk of death was 0.937,which was higher than that of the three alone(P＜0.05).The 28 d survival rates of CCI index,arterial blood ammonia and TLR4 in high-risk patients were lower than those in low-risk patients with the corresponding indexes(P＜0.05).Conclusion CCI index,arterial blood ammonia and TLR4 are closely related to the condition and risk of death in patients with severe multiple injuries combined with sepsis,and the combined testing of the three can improve the predictive value of the prognosis of patients with severe multiple injuries combined with sepsis.
Severe multiple injuriesSepsisCharlson Comorbidity IndexArterial blood ammoniaToll-like receptor 4Risk of death
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