Pi Dandan, Zheng Lijun, Gao Caixia, Xiao Changxue, Yu Zhicai, Fu Yueqiang, Li Jing, Chen Chengzhi, Liu Chengjun, Zou Zhen, Xu Feng
Department of Intensive Care Unit, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China.
Molecular Biology Laboratory of Respiratory Disease, Key Laboratory of Clinical Laboratory Diagnostics (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, China.
Shock. 2024 Oct 1;62(4):488-495. doi: 10.1097/SHK.0000000000002417. Epub 2024 Jul 1.
Background: Pediatric sepsis is a common and complex syndrome characterized by a dysregulated immune response to infection. Aberrations in the renin-angiotensin system (RAS) are factors in several infections of adults. However, the precise impact of RAS dysregulation in pediatric sepsis remains unclear. Methods: Serum samples were collected from a derivation cohort (58 patients with sepsis, 14 critically ill control subjects, and 37 healthy controls) and validation cohort (50 patients with sepsis, 37 critically ill control subjects, and 46 healthy controls). Serum RAS levels on day of pediatric intensive care unit admission were determined and compared with survival status and organ dysfunction. Results: In the derivation cohort, the serum renin concentration was significantly higher in patients with sepsis (3,678 ± 4,746) than that in healthy controls (635.6 ± 199.8) ( P < 0.0001). Meanwhile, the serum angiotensin (1-7) was significantly lower in patients with sepsis (89.7 ± 59.7) compared to that in healthy controls (131.4 ± 66.4) ( P < 0.01). These trends were confirmed in a validation cohort. Nonsurvivors had higher levels of renin (8,207 ± 7,903) compared to survivors (2,433 ± 3,193) ( P = 0.0001) and lower levels of angiotensin (1-7) (60.9 ± 51.1) compared to survivors (104.0 ± 85.1) ( P < 0.05). A combination of renin, angiotensin (1-7) and procalcitonin achieved a model for diagnosis with an area under the receiver operating curve of 0.87 (95% CI: 0.81-0.92). Conclusion: Circulating renin and angiotensin (1-7) have predictive value in pediatric sepsis.
小儿脓毒症是一种常见且复杂的综合征，其特征为对感染的免疫反应失调。肾素 - 血管紧张素系统（RAS）异常是成人多种感染中的因素。然而，RAS失调在小儿脓毒症中的精确影响仍不清楚。方法：从一个推导队列（58例脓毒症患者、14例重症对照受试者和37例健康对照）和验证队列（50例脓毒症患者、37例重症对照受试者和46例健康对照）收集血清样本。测定小儿重症监护病房入院当天的血清RAS水平，并与生存状态和器官功能障碍进行比较。结果：在推导队列中，脓毒症患者的血清肾素浓度（3,678±4,746）显著高于健康对照（635.6±199.8）（P<0.0001）。同时，脓毒症患者的血清血管紧张素（1 - 7）（89.7±59.7）显著低于健康对照（131.4±66.4）（P<0.01）。这些趋势在验证队列中得到证实。与幸存者（2,433±3,193）相比，非幸存者的肾素水平更高（8,207±7,903）（P = 0.0001），与幸存者（104.0±85.1）相比，血管紧张素（1 - 7）水平更低（60.9±51.1）（P<0.05）。肾素、血管紧张素（1 - 7）和降钙素原的组合实现了一个诊断模型，其受试者操作特征曲线下面积为0.87（95%CI：0.81 - 0.92）。结论：循环肾素和血管紧张素（1 - 7）在小儿脓毒症中具有预测价值。
