[预测1500克以下新生儿死亡率的炎症和临床标志物]

[Inflammatory and clinical markers predicting mortality in neonates under 1500 g].

作者信息

González Alma Patricia, Acuña-Cenoz Laura Irandeni, Alcázar-Olaiz Martha Daniela, Estevez-Alemán Pablo Fabián, Paque-Bautista Carlos, Sosa-Bustamante Gloria Patricia

机构信息

Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Dirección de Educación e Investigación en Salud. León, Guanajuato, México.

Universidad de Guanajuato, División de Ciencias de la Salud, Departamento de Medicina y Nutrición. Leon, Guanajuato, México.

出版信息

Rev Med Inst Mex Seguro Soc. 2025 May 2;63(3):e6488. doi: 10.5281/zenodo.15178474.

DOI:10.5281/zenodo.15178474

PMID:40332825

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12129044/

Abstract

BACKGROUND

Early neonatal mortality occurs within 7 days of life. Clinical variables, inflammatory markers and CRIB (Clinical Risk Index for Babies) could be useful to identify mortality risk.

OBJECTIVE

To assess the predictive value of inflammatory and clinical markers for early mortality in preterm newborns (PTNB) < 1500 g.

MATERIAL AND METHODS

Analytical, retroprospective, observational and cross-sectional study. PTNBs with birth weight < 1500 g were included. Clinical characteristics, CRIB, inflammatory markers and C-reactive protein (CRP) were evaluated at 12 hours of life.

RESULTS

248 PTNBs were studied, with a gestational age of 32 weeks (IQR 30-34), weight 1285 g (IQR 1070-1400); 20 died (8.06%). Risk factors for mortality were weight ≤ 1000 g, OR = 24 (7.69-77.96), p < 0.0001; gestational age ≤ 28 weeks, OR = 42 (13.71-128.61), p < 0.0001; invasive ventilation, OR = 44.7 (5.85-340), p < 0.0001. Protective factors were antenatal corticosteroids, OR = 0.15 (0.05-0.39), p = 0.0001, and maternal preeclampsia, OR = 0.13 (0.01-1.02), p = 0.01. CRP, base deficit and birth weight were associated with mortality in the multivariate analysis (intercept = 6.62; SE = 1.85; R2 = 0.60; p = 0.0003). CRP ≥ 2.30 µg/dL showed a sensitivity of 26.32% and a specificity of 97.50% for mortality, AUC = 0.69, p = 0.005.

CONCLUSIONS

Predictors of early mortality were weight ≤ 1000 g, gestational age ≤ 28 weeks and CRP ≥ 2.30 μg/dL.

摘要

背景

早期新生儿死亡发生在出生后7天内。临床变量、炎症标志物和CRIB（婴儿临床风险指数）可能有助于识别死亡风险。

目的

评估炎症和临床标志物对出生体重<1500g的早产新生儿（PTNB）早期死亡的预测价值。

材料与方法

分析性、回顾性、观察性和横断面研究。纳入出生体重<1500g的PTNB。在出生后12小时评估临床特征、CRIB、炎症标志物和C反应蛋白（CRP）。

结果

研究了248例PTNB，胎龄32周（四分位间距30 - 34周），体重1285g（四分位间距1070 - 1400g）；20例死亡（8.06%）。死亡的危险因素为体重≤1000g，OR = 24（7.69 - 77.96），p < 0.0001；胎龄≤28周，OR = 42（13.71 - 128.61），p < 0.0001；有创通气，OR = 44.7（5.85 - 340），p < 0.0001。保护因素为产前使用糖皮质激素，OR = 0.15（0.05 - 0.39），p = 0.0001，以及母亲先兆子痫，OR = 0.13（0.01 - 1.02），p = 0.01。在多变量分析中CRP、碱缺失和出生体重与死亡相关（截距 = 6.62；标准误 = 1.85；R2 = 0.60；p = 0.0003）。CRP≥2.30μg/dL对死亡的敏感性为26.32%，特异性为97.50%，AUC = 0.69，p = 0.005。