A retrospective study on risk factors for prognosis of children with sepsis / 中华危重病急救医学

ABSTRACT

Objective:To explore the risk factors that may affect the prognosis of sepsis in children.Methods:A retrospective study was conducted. Septic children who aged 28 days to 18 years old admitted to the department of critical care medicine of Xi'an Children's Hospital from January 2018 to May 2019 were enrolled. The general demographic data and clinical indicators within 8 hours after admission were collected, and the 28-day mortality was the end point. The differences of the indexes between the survival and the dead children were compared, and the risk factors of prognosis by binary Logistic regression analysis were analyzed. The predictive value of related risk factors on the prognosis was verified by receiver operating characteristic (ROC) curve.Results:A total of 165 children with sepsis were selected, 75 died in 28-days with a 28-day mortality of 45.45%. Compared with the survival group, the alanine aminotransferase (ALT), aspertate aminotransferase (AST), serum creatinine (SCr), creatine kinase isoenzyme (CK-MB), lactate (Lac) and procalcitonin (PCT) in the dead group significantly increased [ALT (U/L) 404.99±88.26 vs. 181.64±35.17, AST (U/L) 453.37±35.37 vs. 210.69±92.50, SCr (μmol/L) 156.46±105.65 vs. 54.32±25.46, CK-MB (U/L) 244.86±53.68 vs. 97.29±19.11, Lac (mmol/L) 5.55±1.66 vs. 2.49±1.29, PCT (ng/L) 35.55±15.87 vs. 18.66±4.91, all P < 0.01], while platelet count (PLT), serum ionized calcium concentration (iCa 2+) significantly decreased [PLT (×10 9/L) 81.49±29.53 vs. 165.43±97.81, iCa 2+ (mmol/L) 0.89±0.16 vs. 1.84±0.14, both P < 0.01]. There was no significant difference in gender, age, prothrombin time (PT), activated partial thromboplastin time (APTT), albumin (ALB) and blood urea nitrogen (BUN) between the two groups. Binary Logistic regression analysis showed that Lac, SCr and PCT were the risk factors for the prognosis of children with sepsis [odds ratio ( OR) and 95% confidence interval (95% CI) were 2.18 (1.22-3.09), 2.01 (1.00-2.07), 1.14 (1.07-1.21), respectively, all P < 0.01], while PLT and iCa 2+ were protective factors [ OR and 95% CI were 0.95 (0.93-0.98), 0.32 (0.12-0.42), respectively, both P < 0.01]. Further ROC curve analysis showed that Lac, PCT and SCr were all of predictive value for the prognosis of children with sepsis, and the area under ROC curve (AUC) was 0.881, 0.864, 0.711, respectively (all P < 0.01); the combined predicted AUC of Lac, SCr, PCT, PLT and iCa 2+ influencing factors was as high as 0.981, with the sensitivity of 97.6%, and the specificity of 98.7%. Conclusion:Lac, PCT and SCr are independent risk factors for the prognosis of children with sepsis.