外周血部分检验项目对脓毒症患儿短期预后的预测价值

目的 探讨脓毒症患儿短期预后的影响因素及外周血中性粒细胞CD64、降钙素原(PCT)、C-反应蛋白(CRP)、中性粒细胞和淋巴细胞比值(NLR)对其的预测价值.方法 回顾性分析2016年1月1日-2019年12月31日某院PICU收治的75例脓毒症患儿的临床资料,比较不同严重程度脓毒症患儿入院24小时危重病例评分(PC...

The Value of Peripheral Blood Partial Examination in Predicting the Short-term Prognosis of Children with Sepsis

Objectives To investigate the influential factors of short-term prognosis in children with sepsis and the predictive value of peripheral blood neutrophil CD64, procalcitonin(PCT), C-reactive protein(CRP), neutrophil and lymphocyte ratio(NLR). Methods Clinical data of 75 children with sepsis admitted to a PICU hospital from January 1 st, 2016 to December 31 st, 2019 were retrospectively analyzed, and the differences in pediatric critical case score(PCIS) within 24 hours of admission in children with different severity of sepsis were compared, as well as the correlation between PCIS score within 24 hours and various test indicators. According to 28 days ill children divided into death group(23 cases) and survival group(52 cases), single factor analysis to compare two groups, the differences between the test indexes such as general data, and using Logistic regression analysis the influence factors of short-term prognosis of sepsis patients, at the same time, through the analysis of the ROC curve drawing related indicators in early detection of sepsis in children with predictive value of short-term prognosis. Results There were statistically significant differences in the 24-hour PCIS scores and the levels of CD64, PCT, CRP and NLR in peripheral blood of children with different degrees of sepsis(P<0.05), and they all showed a gradually increasing trend with the aggravation of the severity of sepsis(P<0.05). PCIS score at 24 hours after admission was negatively correlated with CD64, PCT, CRP and NLR levels in peripheral blood(P<0.05). There were statistically significant differences between the two groups in age, severity of sepsis, continuous blood purification, 24-HOUR PCIS, multiple organ dysfunction syndrome(MODS), and levels of CD64, PCT, CRP and NLR in peripheral blood(P<0.05). With prognostic outcomes(PICU at 28 days of death and survival) as the dependent variable, the single factor analysis of P<0.1 for the independent variable in Logistic regression analysis of relevant indicators, the results showed that the sepsis severity is aggravating, MODS, admitted to hospital 24 h PCIS reduce, peripheral blood CD64, elevated levels of PCT, NLR were 28 days sepsis in children with the independent risk factors of death, continuous blood purification was its protection factor(P<0.05). The ROC curve showed that the AUC value, Jorden index and sensitivity predicted by CD64 of peripheral blood at 24 hours after admission were the highest(0.855, 0.625 and 0.913), and the specificity predicted by PCT was the highest(0.788). The AUC, Yoden index and specificity of combined test were all higher than those of single test(0.962, 0.711 and 0.885). Conclusions There are many factors affecting the short-term prognosis of children with sepsis. Early monitoring of CD64, PCT, CRP and NLR levels in peripheral blood 24 hours after admission is of high predictive value for the short-term prognosis of children with sepsis, while active continuous blood purification at early stage is beneficial to improve the clinical prognosis of children with sepsis.