Objective To investigate the values of cytokines, transcutaneous partial pressure of oxygen (TcPO₂)/fraction of inspiration oxygen (FiO₂) and critical score in predicting short-term progression to septic shock and 28-day prognosis of patients with sepsis.

Methods A total of 96 patients with sepsis admitted to the Emergency Department of Zhongshan Hospital, Fudan University from July 2018 to December 2018 were prospectively screened. According to the inclusion and exclusion criteria, 96 patients with sepsis without shock at admission were enrolled. TcPO₂/FiO₂, cytokines, inflammatory markers, renal function, blood lactic acid and other inflammation-related and perfusion-related indicators were detected on the day of admission. Systematic scoring was performed using the acute physiology and chronic health scoreⅡ (APACHE Ⅱ) system and the sequential organ failure assessment (SOFA). According to septic shock occurrence within 7 days after admission, the patients were divided into shock group (n＝14) and non-shock group (n＝82). According to death within 28 days after admission, the patients were divided into survival group (n＝63) and death group (n＝33). Logistic regression was used to analyze the influencing factors of shock and 28-day prognosis in patients with sepsis, and the receiver operating characteristic (ROC) curve was used to analyze the evaluation value of related indicators for the prognosis of patients with sepsis.

Results The WBC count, cytokines (IL-6, IL-8, IL-10), lactic acid, serum creatinine, and TcPO₂/FiO₂ in septic shock group were all higher than those in non-shock group (P < 0.05). Multivariate logistic regression results showed that higher IL-6 and lower TcPO₂/FiO₂ were independent risk factors for septic shock. The areas under curve (AUC) of IL-6 and TcPO₂/FiO₂ for predicting shock in septic patients were 0.760 (95%CI 0.610-0.911) and 0.813 (95%CI 0.681-0.944), respectively. The AUC of IL-6, TcPO₂/FiO₂ combined SOFA score to predict septic shock was 0.937 (95%CI 0.884-0.991), and the AUC of IL-6, TcPO₂/FiO₂ combined APACHE Ⅱ score was 0.880 (95%CI 0.793-0.968). IL-2R elevation was an independent risk factor for 28-day prognosis, with an AUC of 0.705 (95%CI 0.597-0.814) for predicting 28-day prognosis in patients with sepsis. The AUC of IL-2R combined SOFA score predicting 28-day prognosis was 0.702 (95%CI 0.593-0.810), and the AUC of IL-2R combined APACHE Ⅱ score predicting 28-day prognosis was 0.729 (95%CI 0.626-0.833).

Conclusions Elevated IL-6 and decreased TcPO₂/FiO₂ in sepsis patients could predict the occurrence of septic shock early, and predictive value would further improve when combined with SOFA or APACHE Ⅱ score. Elevated blood IL-2R could indicate poor prognosis of sepsis, and predictive value for 28-day prognosis would further improve when combined with APACHE Ⅱ score.