Clinical characteristics and prognosis of sepsis-associated liver injure in pediatric intensive care unit / 中国小儿急救医学

ABSTRACT

Objective To discuss the incidence,clinical characteristics of sepsis-associated liver injure in pediatric patients and risk factors that may affect the prognosis.Methods A retrospective analysis was made on the data of patients with sepsis-associated liver injure that had been hospitalized in Shanghai Children′s Hospital from January 2011 to December 2015.The cases were divided into the survival group and the death group.Logistic regression analysis was made to screen out risk factors of patients with sepsis-associated liver injure that influence the prognosis.Results The incidence of sepsis associated liver dysfunction was 9.7%(120/1242),the mortality rate was 35.8%(43/120).The most common focus of infection was respiratory tract infection(50.0%),followed by abdominal cavity infection(33.3%) and central nervous system infection(6.7%).The pathogenic microorganisms were mainly gram-negative bacilli(51.3%),followed by virus(26.5%) and gram-positive bacterium(17.7%).The main manifestations of the liver injure were elevated glutamic-pyruvic transaminase(117 cases,97.5%),prolonged prothrombin time(PT)(93 cases,77.5%),hypoproteinemia(83 cases,69.2%) and hyperbilirubinemia(70 cases,58.3%).The total bilirubin(TBIL),PT,activated partial thromboplastin time and total bile acid of the death group were higher than thoes of the survival group.Logistic regression analysis indicated that elevated TBIL(OR=2.937,95%CI 1.179-7.315,P=0.021) was the independent risk factor for death.The area under receiver operating characteristic curve for TBIL(cut off was 64.5μmol/L)was 0.736 with sensitivity 57.7% and specificity 84.8%.Conclusion The incidence rate of sepsis-associated liver injure among pediatric patient is high.Gram-negative bacilli are the main pathogenic microorganisms.This disease is manifested as the elevated glutamic-pyruvic transaminase,hypoproteinemia,prolonged PT and hyperbilirubinemia.Hyperbilirubinemia is the independent risk factor that influences the prognosis.