Value of routine indexes in assessing microcirculation in children with sepsis / 中国医师进修杂志

ABSTRACT

Objective To investigate the value of routine indexes of blood, biochemistry and coagulation in assessing microcirculation in children with sepsis, and explore the related mechanism. Methods The clinical data of 187 children with sepsis from July 2013 to July 2018 in Wuxi Children′s Hospital of Jiangsu Province were retrospectively analyzed. The lactic acid, D- dimmer (DD), platelet distribution width (PDW), red blood cell volume distribution width (RDW), albumin, capillary refill time (CRT), simplify pediatric clinical illness score (PCIS) and prognosis were observed. The children were divided into 3 groups according to the simplify PCIS non-severe group (simplify PCIS＞80 scores, 96 cases), severe group (simplify PCIS 71 to 80 scores, 64 cases), and extremely severe group (simplify PCIS≤70 scores, 27 cases); the children were divided into 2 groups according to the prognosis survival group (161 cases) and death group (26 cases); the children were divided into 3 groups according to the CRT capillary refilling better group (CRT﹤1.0 s, 99 cases), capillary refilling infaust group (CRT 1.0 to 2.9 s, 60 cases), capillary refilling bad group (CRT ≥ 3.0 s, 28 cases). Results The lactic acid, DD, PDW, RDW and fatality rate in non-severe group, severe group and extremely severe group were gradually increased (2.281 ± 1.103), (4.839 ± 2.154), (7.019 ± 3.014) mmol/L; (2.103 ± 0.133), (3.632 ± 0.218), (5.179 ± 0.113) mg/L; 0.122 ± 0.010, 0.149 ± 0.011, 0.177 ± 0.016; 0.137 ± 0.012, 0.151 ± 0.018, 0.169 ± 0.021; 2.08% (2/96), 14.06% (9/64), 55.56% (15/27), while the albumin was gradually decreased (34.21 ± 13.72), (30.38 ± 18.63), (22.37 ± 16.31) g/L, and there were statistical differences (P﹤0.01). The lactic acid, DD, PDW and RDW in survival group were significantly lower than those in death group (3.127 ± 1.312) mmol/L vs. (6.837 ± 2.174) mmol/L, (2.473 ± 1.713) mg/L vs. (4.213 ± 1.101) mg/L, 0.124 ± 0.012 vs. 0.170 ± 0.023 and 0.148 ± 0.022 vs. 0.171 ± 0.017, while the albumin was significantly higher than that in death group (33.59 ± 16.90) g/L vs. (19.92 ± 18.70) g/L, and there were statistical differences (P﹤0.01 or﹤0.05). The lactic acid, DD, PDW and RDW in capillary refilling better group, capillary refilling infaust group and capillary refilling bad group were gradually increased (2.362 ± 2.131), (5.312 ± 1.114), (8.121 ± 2.213) mmol/L; (2.072 ± 0.213), (3.923 ± 0.178), (5.317 ± 0.517) mg/L; 0.119 ± 0.021, 0.153 ± 0.012, 0.171 ± 0.011; 0.127 ± 0.021, 0.148 ± 0.015, 0.168 ± 0.027; while the albumin was gradually decreased (35.37 ± 14.11), (31.21 ± 15.13), (22.87 ± 15.22) g/L, and there were statistical differences (P﹤0.01). Conclusions The lactic acid, DD, PDW, RDW, ALB and CRT have some value in assessing microcirculation in children with sepsis, and the change of component and construction in microcirculation is the cause of developing of these indexes.