摘要
目的探讨可能影响脓毒症患儿预后的相关危险因素。方法采用回顾性研究方法,选择2018年1月至2019年5月在西安交通大学附属儿童医院重症医学科收治的28 d^18岁的脓毒症患儿作为研究对象。收集患儿的人口学资料及入院8 h内临床指标;以28 d病死率为终点事件。比较存活患儿与死亡患儿各指标的差异,对影响预后的危险因素进行二元Logistic回归分析;并用受试者工作特征曲线(ROC)分析验证相关危险因素对预后的预测价值。结果入选165例脓毒症患儿,28 d死亡75例,病死率为45.45%。与存活组比较,死亡组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血肌酐(SCr)、肌酸激酶同工酶(CK-MB)、血乳酸(Lac)、降钙素原(PCT)明显升高〔ALT(U/L):404.99±88.26比181.64±35.17,AST(U/L):453.37±35.37比210.69±92.50,SCr(µmol/L):156.46±105.65比54.32±25.46,CK-MB(U/L):244.86±53.68比97.29±19.11,Lac(mmol/L):5.55±1.66比2.49±1.29,PCT(ng/L):35.55±15.87比18.66±4.91,均P<0.01〕,血小板计数(PLT)、血清离子钙浓度(iCa^2+)明显降低〔PLT(×10^9/L):81.49±29.53比165.43±97.81,iCa^2+(mmol/L):0.89±0.16比1.84±0.14,均P<0.01〕,而两组间性别、年龄、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血白蛋白(ALB)、血尿素氮(BUN)比较差异均无统计学意义。二元Logistic回归分析显示,Lac、SCr、PCT为影响脓毒症患儿预后的危险因素〔优势比(OR)和95%可信区间(95%CI)分别为2.18(1.22~3.09)、2.01(1.00~2.07)、1.14(1.07~1.21),均P<0.01〕,PLT、iCa^2+为保护性因素〔OR和95%CI分别为0.95(0.93~0.98)、0.32(0.12~0.42),均P<0.01〕。进一步ROC曲线分析显示,Lac、PCT、SCr均对脓毒症患儿预后有预测价值,ROC曲线下面积(AUC)分别为0.881、0.864、0.711(均P<0.01);Lac、SCr、PCT、PLT、iCa^2+等影响因素联合预测的AUC高达0.981,敏感度为97.6%,特异度为98.7%。结论Lac、PCT、SCr是影响脓毒症患儿预后的独立危险因素。
Objective To explore the risk factors that may affect the prognosis of sepsis in children.Methods A retrospective study was conducted.Septic children who aged 28 days to 18 years old admitted to the department of critical care medicine of Xi'an Children's Hospital from January 2018 to May 2019 were enrolled.The general demographic data and clinical indicators within 8 hours after admission were collected,and the 28-day mortality was the end point.The differences of the indexes between the survival and the dead children were compared,and the risk factors of prognosis by binary Logistic regression analysis were analyzed.The predictive value of related risk factors on the prognosis was verified by receiver operating characteristic(ROC)curve.Results A total of 165 children with sepsis were selected,75 died in 28-days with a 28-day mortality of 45.45%.Compared with the survival group,the alanine aminotransferase(ALT),aspertate aminotransferase(AST),serum creatinine(SCr),creatine kinase isoenzyme(CK-MB),lactate(Lac)and procalcitonin(PCT)in the dead group significantly increased[ALT(U/L):404.99±88.26 vs.181.64±35.17,AST(U/L):453.37±35.37 vs.210.69±92.50,SCr(µmol/L):156.46±105.65 vs.54.32±25.46,CK-MB(U/L):244.86±53.68 vs.97.29±19.11,Lac(mmol/L):5.55±1.66 vs.2.49±1.29,PCT(ng/L):35.55±15.87 vs.18.66±4.91,all P<0.01],while platelet count(PLT),serum ionized calcium concentration(iCa^2+)significantly decreased[PLT(×10^9/L):81.49±29.53 vs.165.43±97.81,iCa^2+(mmol/L):0.89±0.16 vs.1.84±0.14,both P<0.01].There was no significant difference in gender,age,prothrombin time(PT),activated partial thromboplastin time(APTT),albumin(ALB)and blood urea nitrogen(BUN)between the two groups.Binary Logistic regression analysis showed that Lac,SCr and PCT were the risk factors for the prognosis of children with sepsis[odds ratio(OR)and 95%confidence interval(95%CI)were 2.18(1.22-3.09),2.01(1.00-2.07),1.14(1.07-1.21),respectively,all P<0.01],while PLT and iCa^2+were protective factors[OR and 95%CI were 0.95(0.93-0.98),0.32(0.12-0.42),respectively,both P<0.01].Further ROC curve analysis showed that Lac,PCT and SCr were all of predictive value for the prognosis of children with sepsis,and the area under ROC curve(AUC)was 0.881,0.864,0.711,respectively(all P<0.01);the combined predicted AUC of Lac,SCr,PCT,PLT and iCa^2+influencing factors was as high as 0.981,with the sensitivity of 97.6%,and the specificity of 98.7%.Conclusion Lac,PCT and SCr are independent risk factors for the prognosis of children with sepsis.
作者
王义
张华
唐小晶
李晓娟
Wang Yi;Zhang Hua;Tang Xiaojing;Li Xiaojuan(Department of Neonatal Intensive Care Unit,Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710003,Shaanxi,China;Zhangjiapu Community Health Service Center of Weiyang District,Xi'an 710018,Shaanxi,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第6期707-710,共4页
Chinese Critical Care Medicine
基金
陕西省省级重点专科建设项目(2019-377)。
