白蛋白相关比值对儿童脓毒症预后的预测价值

目的 评估白蛋白（serum albumin,ALB）相关比值对儿童脓毒症预后的预测价值。 方法 选取脓毒症患儿193例，根据28 d生存情况分为存活组(132例)和死亡组(61例)。收集患儿入院24 h内白细胞计数(white blood cell count,WBC)、中性粒细胞计数（neutrophil count,NEU）、C反应蛋白（C-reactive protein,CRP）、降钙素原（procalcitonin,PCT）、血乳酸（blood lactic acid,Lac）及血清ALB。记录患儿入PICU 24 h内小儿死亡危险(pediatric risk of mortality Ⅲ,PRISM Ⅲ)评分。分析确定脓毒症患儿死亡的危险因素、ALB与其他指标的相关性；计算ALB相关比值NEU/ALB、CRP/ALB、Lac/ALB；使用受试者工作特征曲线评估ALB、NEU/ALB、CRP/ALB、Lac/ALB、PRISM Ⅲ评分对脓毒症患儿预后的预测价值，并绘制Kaplan-Meier生存曲线。 结果 死亡组PRISM Ⅲ评分高于存活组，ALB低于存活组，差异有统计学意义(P＜0.05)。ALB与PRISM Ⅲ评分、NEU、CRP、Lac呈正相关（P＜0.05）。死亡组NEU/ALB、CRP/ALB、Lac/ALB均高于存活组，差异有统计学意义(P＜0.05)。Lac/ALB对脓毒症患儿28 d死亡的预测价值最高，敏感度最高，特异度仅次于CRP/ALB；CRP/ALB对脓毒症患儿28 d死亡的预测价值不及Lac/ALB，敏感度较低。以脓毒症患儿28 d预后为结局，ALB、PRISM Ⅲ评分、NEU/ALB、CRP/ALB、Lac/ALB正常水平组存活率高于相应指标的异常水平组，平均生存时间长于相应指标的异常水平组，差异有统计学意义(P＜0.05)。 结论 NEU/ALB、CRP/ALB、Lac/ALB是很容易获得的预后指标，可以识别预后较差的脓毒症患儿。Lac/ALB提高了对脓毒症患儿预后的预测价值和敏感度。

The prognostic value of albumin-related ratio in children with sepsis

Objective To evaluate the predictive value of albumin-related ratio in the prognosis of children with sepsis.Methods In total, 193 children with sepsis were selected as the research subjects. According to the 28-day survival, they were divided into survival group(n=132) and death group(n=61). The white blood cell count(WBC), neutrophil count(NEU), C-reactive protein(CRP), procalcitonin(PCT), blood lactic acid(Lac) and serum albumin(ALB) were collected within 24 h after admission. The pediatric risk of mortality Ⅲ(PRISM Ⅲ) was recorded within 24 h after PICU admission. Risk factors of death in children with sepsis, and the correlation between ALB and other indicators was analyzed; albumin-related ratio, including NEU/ALB, CRP/ALB, Lac/ALB were calculated. Receiver operating characteristic(ROC) curve was used to evaluate the predictive value of ALB, NEU/ALB, CRP/ALB, Lac/ALB, and PRISM Ⅲ in the prognosis of children with sepsis, and Kaplan Meier survival curve was drawn.Results PRISM Ⅲ score of death group was higher than that of survival group, while ALB was lower than that of survival group, and the difference was statistically significant(P＜0.05). ALB was positively correlated with PRISM Ⅲ, NEU, CRP and Lac(P＜0.05). NEU/ALB, CRP/ALB, and Lac/ALB of death group was higher than those of survival group, and the difference was statistically significant(P＜0.05). Lac/ALB had the highest predictive value in 28-day mortality of children with sepsis, its sensitivity was the highest, and its specificity was second only to CRP/ALB. CRP/ALB had a lower predictive value in 28-day mortality of children with sepsis than Lac/ALB, and its sensitivity was lower. With 28-day prognosis of children with sepsis as the outcome, survival rate of patients in ALB, PRISM Ⅲ score, NEU/ALB, CRP/ALB, and Lac/ALB of normal level group was higher than that in the corresponding indexes of abnormal level group, and the difference was statistically significant(P＜0.05).Conclusion NEU/ALB, CRP/ALB, and Lac/ALB are easily obtained prognostic indicators, which can identify septic children with poor prognosis. Lac/ALB improves the predictive value and sensitivity of prognosis in children with sepsis.