中国实用儿科杂志

中国实用儿科杂志

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儿童严重脓毒症预后因素分析（附178例报告）

  

  1. 西安交通大学附属儿童医院新生儿重症监护病房，陕西  西安  710003
  • 出版日期:2020-08-06 发布日期:2020-09-07

Clinical analysis of prognostic factors of severe sepsis in children: A report of 178 cases

  1. Neonatal Intensive Care Unit，Affiliated Children’s Hospital of Xi’an Jiao Tong University，Xi’an  710003，China
  • Online:2020-08-06 Published:2020-09-07

摘要： 目的　探讨影响儿童严重脓毒症预后的危险因素。方法　回顾性分析2018年4月至2019年6月在西安交通大学附属儿童医院重症医学科就诊的178例严重脓毒症患儿的临床资料。数据分析采用SPSS 20.0统计学软件，以预后为因变量，基础变量构成比采用χ2检验，对纳入满足正态分布的变量进行独立样本t检验，二元Logistic回归对各变量进行预后评价，对具有预测价值的变量采用受试者工作特征曲线（ROC）进行特异性预测，以曲线下面积（AUC）＞0.5为具有预测价值。结果　共收集到严重脓毒症患儿178例，其中包括有脓毒性休克、脓毒症并急性呼吸窘迫综合征和脓毒症并多器官功能障碍综合征。存活组和死亡组在年龄、性别方面差异无统计学意义，在凝血酶原时间、部分凝血活酶时间、国际标准化比值、血白蛋白、血尿素氮等方面无统计学差异，Logistic回归筛选发现肌酐、乳酸、前降钙素原、可能是影响预后的变量，通过ROC曲线发现肌酐敏感度0.736、特异度0.745、临界浓度148.5 mmol/L、AUC 0.625；前降钙素原敏感度0.679、特异度0.904、临界浓度16.7 ng/L、AUC 0.865；乳酸敏感度0.786、特异度0.862、临界浓度3.70 mmol/L、AUC 0.875，对预后具有预测价值，而且前降钙素原与乳酸的拟合度较好，特异度高于肌酐。结论　肌酐、前降钙素原、乳酸是影响儿童严重脓毒症预后的独立危险因素。

关键词: 脓毒症, 前降钙素原, 预后

Abstract: Objective　To explore the risk factors of prognosis of severe sepsis in children. Methods　The clinical data of 178 children with severe sepsis admitted from April 2018 to June 2019 to Department of Critical Medicine，Affiliated Children’s Hospital of Xi’an Jiao Tong University，were analyzed retrospectively. The data were analyzed by SPSS20.0 statistical software. Prognosis of severe sepsis was taken as the dependent variable. Categorical variables were compared using a Pearson’s Chi-square test. An independent sample t-test was performed to compare the paired differences of quantitative variables with normal distribution. Binary Logistic regression was used to evaluate all the variables，and then receiver operating characteristic（ROC） was used to predict the specificity of the variables with predictive value. The area under the curve（AUC）＞0.5 was considered as with predictive value. Results　A total of 178 children with serve sepsis were collected，including septic shock，sepsis with acute respiratory distress syndrome and sepsis with multiple organ dysfunction syndrome. There was no significant difference in age，gender，prothrombin time（PT），activated partial thromboplastin time（APTT），international normalized ratio（INR），serum albumin（ALB）or blood urea nitrogen（BUN） between the survival group and death group. Logistic regression analysis showed that serum creatinine（CRE），blood lactate（Lac） and procalcitonin（PCT） might be the prognostic variables. ROC curve showed that CRE-related sensitivity was 0.736，specificity was 0.745，critical concentration was 148.5 mmol/L and AUC was 0.625；PCT-related sensitivity was 0.679，specificity was 0.904，critical concentration was 16.7 ng/L and AUC was 0.865；Lac-related sensitivity was 0.786，specificity was 0.862，critical concentration was 3.70 mmol/L and AUC was 0.875. Those values had predictive value of prognosis. Meanwhile，the fitting degree of PCT and Lac was relatively high，and the specificity was higher than that of CRE. Conclusion　CRE，PCT and Lac are independent risk factors for the prognosis of serve sepsis in children.

Key words: sepsis, procalcitonin, prognosis