Zakirov Rustam, Petrichuk Svetlana, Yanyushkina Olga, Semikina Elena, Vershinina Marina, Karaseva Olga
National Medical Research Center for Children's Health, 119296 Moscow, Russia.
Clinical and Research Institute of Emergency Pediatric Surgery and Traumatology, 119180 Moscow, Russia.
Biomedicines. 2023 Aug 19;11(8):2306. doi: 10.3390/biomedicines11082306.
The development of multiple organ failure and septic complications increases the cumulative risk of mortality in children with severe injury. Clinically available biochemical markers have shown promise in assessing the severity and predicting the development of complications and outcomes in such cases. This study aimed to determine informative criteria for assessing the severity and outcome prediction of severe injury in children based on levels of mid-regional proadrenomedullin (MR-proADM) procalcitonin (PCT), neuron-specific enolase (NSE), and protein S100. Biomarker levels were measured in 52 children with severe injury (ISS ≥ 16) on the 1st, 3rd, 7th, and 14th days after admission to the ICU. The children were divided into groups based on their favorable (n = 44) or unfavorable (n = 8) outcomes according to the Severe Injury Outcome Scale, as well as their favorable (n = 35) or unfavorable (n = 15) outcomes according to the Glasgow Coma Outcome Scale (GOS). The study also evaluated the significance of biomarker levels in predicting septic complications (with SC (n = 16) and without SC (n = 36)) and diagnosing and stratifying multiple organ failure (with MOF (n = 8) and without MOF (n = 44)). A comprehensive assessment of MR-proADM and PCT provided the highest diagnostic and prognostic efficacy for early diagnosis, risk stratification of multiple organ failure, and outcome prediction in severe injury cases involving children. Additionally, the inclusion of the S100 protein in the study allowed for further assessment of brain damage in cases of traumatic brain injury (TBI), contributing to the overall prognostic model.
多器官功能衰竭和脓毒症并发症的发生增加了重伤儿童的累积死亡风险。临床可用的生化标志物在评估此类病例的严重程度以及预测并发症和预后方面已显示出前景。本研究旨在基于中段肾上腺髓质素原（MR-proADM）、降钙素原（PCT）、神经元特异性烯醇化酶（NSE）和S100蛋白水平，确定评估儿童重伤严重程度和预后预测的信息标准。在52例重伤儿童（损伤严重度评分≥16）入住重症监护病房后的第1天、第3天、第7天和第14天测量生物标志物水平。根据严重损伤结局量表，将儿童分为预后良好组（n = 44）和预后不良组（n = 8）；根据格拉斯哥昏迷结局量表（GOS），将儿童分为预后良好组（n = 35）和预后不良组（n = 15）。该研究还评估了生物标志物水平在预测脓毒症并发症（有脓毒症并发症（n = 16）和无脓毒症并发症（n = 36））以及诊断和分层多器官功能衰竭（有多器官功能衰竭（n = 8）和无多器官功能衰竭（n = 44））方面的意义。对MR-proADM和PCT的综合评估为涉及儿童的严重损伤病例的早期诊断、多器官功能衰竭的风险分层和预后预测提供了最高的诊断和预后效能。此外，将S100蛋白纳入研究有助于在创伤性脑损伤（TBI）病例中进一步评估脑损伤，完善整体预后模型。
