Santolaya Maria E, Alvarez Ana M, Aviles Carmen L, Becker Ana, King Alejandra, Mosso Claudio, O'Ryan Miguel, Paya Ernesto, Salgado Carmen, Silva Pamela, Topelberg Santiago, Tordecilla Juan, Varas Monica, Villarroel Milena, Viviani Tamara, Zubieta Marcela
Department of Pediatrics, Hospital Luis Calvo Mackenna, Santiago, Chile.
Pediatr Infect Dis J. 2008 Jun;27(6):538-43. doi: 10.1097/INF.0b013e3181673c3c.
Severe sepsis is not clinically apparent during the first 24 hours of hospitalization in most children with cancer and febrile neutropenia (FN), delaying targeted interventions that could impact mortality. The aim of this study was to prospectively evaluate biomarkers obtained within 24 hours of hospitalization as predictors of severe sepsis before it becomes clinically evident.
Children with cancer, admitted with FN at high risk for an invasive bacterial infection in 6 public hospitals in Santiago, Chile, were monitored throughout their clinical course for occurrence of severe sepsis. Clinical, demographic and 6 biomarkers [eg, blood urea nitrogen, serum glucose, lactic dehydrogenase, serum C-reactive protein (CRP), interleukin (IL)-8, and procalcitonin] were obtained at the time of admission and after 24 hours. Biomarkers independently associated with severe sepsis diagnosed after the first 24 hours of hospitalization were identified by logistic regression analysis.
A total of 601 high risk FN episodes were enrolled between June 2004 and October 2006; 151 (25%) developed severe sepsis of which 116 (77%) were not clinically apparent during the first 24 hours of hospitalization. Risk factors for severe sepsis were age > or =12 years [odds ratio (OR): 3.85; 95% confidence interval (CI): 2.41-6.15], admission CRP > or =90 mg/L (OR: 2.03; 95% CI: 1.32-3.14), admission IL-8 > or =200 pg/mL (OR: 2.39; 95% CI: 1.51-3.78), 24-hour CRP > or =100 mg/L (OR: 3.06; 95% CI: 1.94-4.85), and 24-hour IL-8 > or =300 pg/mL (OR: 3.13; 95% CI 1.92-5.08).
Age > or =12 years and admission or 24-hour values of CRP > or =90/100 mg/L and IL-8 > or =200/300 pg/mL are predictors of sepsis not clinically apparent during the first 24 hours of hospitalization.
在大多数患有癌症和发热性中性粒细胞减少症（FN）的儿童住院的最初24小时内，严重脓毒症在临床上并不明显，这延误了可能影响死亡率的针对性干预措施。本研究的目的是前瞻性评估住院24小时内获得的生物标志物，作为严重脓毒症在临床上显现之前的预测指标。
在智利圣地亚哥的6家公立医院，对因FN入院且有侵袭性细菌感染高风险的癌症患儿在其整个临床过程中监测严重脓毒症的发生情况。入院时和24小时后获取临床、人口统计学和6种生物标志物[如血尿素氮、血糖、乳酸脱氢酶、血清C反应蛋白（CRP）、白细胞介素（IL）-8和降钙素原]。通过逻辑回归分析确定与住院24小时后诊断的严重脓毒症独立相关的生物标志物。
2004年6月至2006年10月共纳入601例高风险FN发作；151例（25%）发生严重脓毒症，其中116例（77%）在住院最初24小时内临床上不明显。严重脓毒症的危险因素为年龄≥12岁[比值比（OR）：3.85；95%置信区间（CI）：2.41 - 6.15]、入院时CRP≥90 mg/L（OR：2.03；95% CI：1.32 - 3.14）、入院时IL-8≥200 pg/mL（OR：2.39；95% CI：1.51 - 3.78）、24小时CRP≥100 mg/L（OR：3.06；95% CI：1.94 - 4.85）以及24小时IL-8≥300 pg/mL（OR：3.13；95% CI 1.92 - 5.08）。
年龄≥12岁以及入院时或24小时时CRP≥90/100 mg/L和IL-8≥200/300 pg/mL是住院最初24小时内临床上不明显的脓毒症的预测指标。
