多项血清学指标与布莱顿儿科早期预警评分预测脓毒症患儿死亡的巢式病例对照研究
Nested case-control study of multiple serological indexes and Brighton pediatric early warming score in predicting death of children with sepsis.
作者信息
Xie Xiong, Li Ming, Xiong Tian-Tian, Wang Rui, Xiao Liang
机构信息
Tian-tian Xiong, Rui Wang, Liang Xiao, Department of Pediatrics, Third Clinical Hospital, China Three Gorges University, Gezhouba Central Hospital, Yichang 443002, Hubei Province, China.
出版信息
World J Clin Cases. 2019 Feb 26;7(4):431-440. doi: 10.12998/wjcc.v7.i4.431.
BACKGROUND
Currently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score (PEWS) is a disease risk assessment system that is simple and easy to operate, which has good sensitivity and specificity in disease recognition among children. Because detection indicators vary widely in children, a single indicator is difficult to assess the post-treatment status of children with sepsis.
AIM
To investigate the relationship between serological markers, Brighton PEWS, and death in children with sepsis after treatment.
METHODS
A total of 205 children diagnosed with sepsis at our hospital were enrolled. The baseline data, serum scores, and PEWS scores were recorded. In the nested case-control study, children who died during the study period were included in an observation group. According to the matching principle, the children who were not dead in the same cohort were included in a control group. The influencing factors of death in children with sepsis after treatment and the value of each evaluation index in predicting the prognosis of children were analyzed.
RESULTS
A total of 96 children were enrolled in the study, including 48 each in the observation group and the control group. Multivariate logistic regression analysis indicated that antibacterial treatments within 1 h ( = 0.017), shock ( = 0.044), multiple organ dysfunction syndrome (MODS) ( = 0.027), serum procalcitonin (PCT) ( = 0.047), serum albumin (ALB) ( = 0.024), and PEWS ( = 0.012) were independent risk factors for the death of children with sepsis. The area under the curve of the combination of ALB, PCT, and PEWS to predict the death in children with sepsis was the highest (0.908).
CONCLUSION
Antibacterial treatments within 1 h, shock, MODS, PCT, ALB, and PEWS are independent risk factors for the death of children with sepsis. The predictive accuracy of the combination of PCT, ALB, and PEWS for the prognosis of children with sepsis is the best.
背景
目前，脓毒症患儿早期并发症难以预测。布莱顿儿科早期预警评分（PEWS）是一种操作简单的疾病风险评估系统，在儿童疾病识别中具有良好的敏感性和特异性。由于儿童检测指标差异较大，单一指标难以评估脓毒症患儿治疗后的状况。
目的
探讨脓毒症患儿治疗后血清学标志物、布莱顿PEWS与死亡之间的关系。
方法
选取我院确诊为脓毒症的205例患儿。记录基线数据、血清评分和PEWS评分。在巢式病例对照研究中，将研究期间死亡的患儿纳入观察组。根据匹配原则，将同一队列中未死亡的患儿纳入对照组。分析脓毒症患儿治疗后死亡的影响因素及各评估指标对患儿预后的预测价值。
结果
共纳入96例患儿，观察组和对照组各48例。多因素logistic回归分析显示，1 h内抗菌治疗（=0.017）、休克（=0.044）、多器官功能障碍综合征（MODS）（=0.027）、血清降钙素原（PCT）（=0.047）、血清白蛋白（ALB）（=0.024）和PEWS（=0.012）是脓毒症患儿死亡的独立危险因素。ALB、PCT和PEWS联合预测脓毒症患儿死亡的曲线下面积最高（0.908）。
结论
1 h内抗菌治疗、休克、MODS、PCT、ALB和PEWS是脓毒症患儿死亡的独立危险因素。PCT、ALB和PEWS联合对脓毒症患儿预后的预测准确性最佳。
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