Risk factors for septic shock and changes of TLR4/MyD88 pathway in patients with decompensated cirrhosis
OBJECTIVE To explore the risk factors of septic shock in patients with decompensated cirrhosis and the changes of toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)pathway.METHODS The clini-cal data of 95 patients with decompensated cirrhosis with septic shock in Jingzhou Central Hospital from Jan 2020 to Jan 2023 were retrospectively collected and analyzed as the infected group,and the clinical data of 95 patients with decompensated cirrhosis without septic shock were in the non-infected group.The distribution of pathogenic bacteria in decompensated cirrhosis patients with septic shock were analyzed and the risk factors were identified analyzed.Protein expression levels of TLR4 and MyD88 were compared between the two groups,and the diagnos-tic value of TLR4 and MyD88 individual and combined detection in the diagnosis of septic shock in patients with decompensated cirrhosis was analyzed.RESULTS A total of 96 strains of pathogenic bacteria were isolated in the infection group,mainly gram-negative bacteria Escherichia coli and Klebsiella pneumoniae.Age,long hospital stay,diabetes and pulmonary infection were risk factors for septic shock in decompensated cirrhosis patients(P＜0.05).Compared with the uninfected group,the levels of TLR4 and MyD88 in the infected group were increased(P＜0.05).The AUC value of peripheral blood TLR4 and MyD88 combined detection in septic shock in patients with decompensated cirrhosis,with the sensitivity of 90.53％and the specificity of 90.53％,was higher than that of single detection(P＜0.05).CONCLUSION Gram-negative bacteria E.coli and K.pneumoniae were the main pathogenic bacteria in decompensated cirrhosis patients with septic shock.The risk factors for septic shock are old age,long hospital stay,diabetes mellitus and pulmonary infection.The disease is related to abnormal expression of TLR4/MyD88 pathway.TLR4 and MyD88 combined detection may have high diagnostic value for septic shock in patients with decompensated cirrhosis.
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