Objective To construct a 28-day survival prognosis prediction model for sepsis patients based on the dynamic changes of serum inflammatory factors and to verify the predictive effectiveness of the model. Methods A retrospective analysis was conducted on the medical records of 187 sepsis patients admitted to the general ward and Intensive Care Unit(ICU) of the Emergency Medicine Department at the Emergency Medicine Center of Nantong University Affiliated Hospital between November 2022 and November 2025. They were divided into a survival group and a mortality group based on their 28-day survival status. Serum procalcitonin(PCT) and high-sensitivity C-reactive protein(hs-CRP) levels were measured immediately upon admission(T0), 48 hours after admission(T1), 72 hours after admission(T2), and 7 days after admission(T3), and baseline data of the patients were collected. Independent risk factors for poor 28-day survival prognosis were identified through Cox regression analysis, and a nomogram prediction model was constructed based on these factors. The predictive efficacy, calibration degree, and clinical practicability of the model were evaluated through receiver operating characteristic(ROC) curve analysis, calibration curve analysis, and decision curve analysis. Results Of the 187 patients, 169 survived and 18 died, with a 28-day all-cause mortality rate of 9.63%. The proportion of patients aged ≥60 years and the Sequential Organ Failure Assessment(SOFA) score were significantly higher in the mortality group than in the survival group(χ2/P=8.393/0.004, t/P=4.259/<0.001). Serum PCT and hs-CRP levels in the survival group showed a gradually decreasing trend at T1, T2, and T3 compared to T0(F/P=222.729/<0.001, 287.902/<0.001). In the mortality group, serum PCT and hs-CRP levels showed a gradually increasing trend at T1 and T2 compared to T0, and decreased at T3(F/P=39.319/<0.001, 56.831/<0.001). The levels of PCT and hs-CRP in the mortality group at T1–T3 were significantly higher than those in the survival group(t/P=19.908/<0.001、65.848/<0.001,60.545/<0.001、79.925/<0.001,29.775/<0.001、332.407/<0.001). Compared with the survival group, the mortality group showed significantly higher ΔPCT and Δhs-CRP(t/P=5.411/<0.001, 7.529/<0.001). Age ≥60 years, high SOFA score, and high levels of ΔPCT and Δhs-CRP were independent risk factors for poor 28-day survival prognosis in sepsis patients [HR(95%CI)=4.632(1.405-15.275), 1.263(1.040-1.533), 1.350(1.204-1.513), 4.632(1.405-15.275)]. Based on the independent risk factors mentioned above, a nomogram prediction model was constructed, with an area under the ROC curve(AUC) of 0.949, sensitivity of 0.793, specificity of 0.944, and Youden index of 0.737, indicating good predictive performance. The calibration curve showed good consistency between the predicted values of the model and the actual 28-day mortality rate. The decision curve suggested that the model had a good clinical net benefit within the threshold range of 0.01-0.99. Conclusion The nomogram model based on dynamic changes in serum PCT and hs-CRP(ΔPCT, Δhs-CRP), age ≥60 years, and SOFA score has good predictive power for the 28-day survival prognosis of sepsis patients, and the model calibration and clinical practicality are both good.

Objective To investigate the correlation between serum basic helix-loop-helix ARNT like 1(BMAL1) and soluble complement receptor 1(sCR1) levels and myocardial injury in patients with sepsis-related myocardial injury(SRMI) and their prognostic value. Methods A total of 155 patients with SRMI admitted to the Department of Emergency Medicine, General Hospital of Eastern Theater Commander from January 2023 to June 2025 were selected as the SRMI group, and 155 patients with simple sepsis admitted in the same period were selected as the simple sepsis group at a 1:1 ratio. Serum levels of BMAL1, sCR1 and myocardial injury markers [creatine kinase isoenzyme(CK-MB), cardiac troponin I(cTnI), myoglobin(Mb), brain natriuretic peptide(BNP)] were measured. Pearson correlation analysis was used to analyze the correlation between serum BMAL1, sCR1 and myocardial injury markers in patients with SRMI. Based on 28-day outcomes, SRMI patients were divided into a death subgroup and a survival subgroup. Factors influencing poor prognosis and the predictive efficacy of serum BMAL1 and sCR1 levels were analyzed. Results Compared with the simple sepsis group, serum BMAL1 levels were significantly decreased, while levels of sCR1, CK-MB, cTnI, Mb, and BNP were significantly increased in the SRMI group(t/P=16.536/<0.001, 14.962/<0.001, 17.631/<0.001, 30.884/<0.001, 20.173/<0.001, 21.827/<0.001). Serum BMAL1 was negatively correlated with CK-MB, cTnI, Mb, and BNP levels in SRMI patients(r/P=-0.605/<0.001,-0.612/<0.001,-0.552/<0.001,-0.565/<0.001), while sCR1 was positively correlated with these markers(r/P=0.518/<0.001, 0.618/<0.001, 0.589/<0.001, 0.581/<0.001). The 28-day mortality rate of the 155 SRMI patients was 40.00%(62/155). The death subgroup had significantly higher SOFA score, lactic acid, CK-MB, cTnI, Mb, BNP, and sCR1 levels, and significantly lower BMAL1 levels compared with the survival subgroup(t/P=7.124/<0.001, 6.337/<0.001, 4.956/<0.001, 2.900/<0.001, 4.522/<0.001, 5.950/<0.001, 7.187/<0.001, 7.681/<0.001). Increased SOFA score, increased lactic acid, increased cTnI, increased BNP, and increased sCR1 were independent risk factors for death in SRMI patients, while increased BMAL1 was an independent protective factor [OR(95%CI)=1.251(1.078-1.451), 4.594(2.027-10.414), 1.318(1.113-1.560), 1.011(1.004-1.018), 1.202(1.082-1.335), 0.301(0.157-0.576)]. The AUCs of serum BMAL1, sCR1, and their combination for predicting poor prognosis were 0.808, 0.795, and 0.904, respectively. The combined prediction showed significantly better performance than either marker alone(Z/P=3.612/<0.001, 3.574/<0.001). Conclusion Decreased serum BMAL1 and increased sCR1 levels in SRMI patients are associated with aggravated myocardial injury and poor prognosis. The combination of serum BMAL1 and sCR1 levels has high predictive value for prognosis.

Objective To investigate the changes and clinical value of serum microRNA-181c(miR-181c) and miR-663b levels in patients with sepsis after burns. Methods From January 2019 to April 2024, 80 burn patients who developed sepsis after admission to the Department of Burn and Plastic Surgery of Longhua District Central Hospital in Shenzhen were selected as the observation group, and another 80 burn patients who did not develop sepsis were selected as the control group. Pathogenic bacteria were cultured and detected from wound secretions of burn patients. Serum levels of miR-181c and miR-663b were measured using quantitative real-time PCR. Logistic regression was used to analyze the influencing factors for sepsis in burn patients, and ROC curves were drawn to evaluate the diagnostic value of serum miR-181c and miR-663b for sepsis in burn patients. Results Among 80 specimens from patients with sepsis following burns, a total of 94 pathogenic strains were isolated, including 40 strains of Gram-positive bacteria(mainly Staphylococcus aureus and Staphylococcus epidermidis)(42.55%), 51 strains of Gram-negative bacteria and 3 strains of fungi(3.19%). Serum levels of miR-181c and miR-663b in the observation group were significantly higher than those in the control group(t=9.476, 7.132; both P<0.001). High serum miR-181c and high serum miR-663b levels were independent risk factors for sepsis in patients after burns [OR(95%CI)=2.867(1.377-5.967), 3.152(1.422-6.985)]. The AUC for predicting sepsis in burn patients was 0.858 for serum miR-181c, 0.811 for miR-663b, and 0.938 for the combination of both, with the combined prediction being significantly superior to either alone(Z=2.531, 2.486; P=0.018, 0.019). Conclusion Serum levels of miR-181c and miR-663b are elevated in patients with sepsis after burns. Combined detection of these two biomarkers has good diagnostic value for sepsis after burns.

Department of Emergency,The First Affiliated Hospital of Xi'an Jiaotong University