Heart-type fatty acid-binding protein predicts the prognosis of pediatric severe pneumonia complicated by acute respiratory distress syndrome / 中国小儿急救医学

ABSTRACT

Objective To investigate the prognostic value of heart-type fatty acid-binding protein ( H-FABP) in pediatric patients with severe pneumonia complicated by acute respiratory distress syndrome ( ARDS) . Methods We performed a retrospective study to summarize the medical records of 59 pediatric patients with severe pneumonia complicated by ARDS admitted to the PICU at Shanghai Children′s Hospital between November 2016 and October 2017. According to the ratio of PaO2 to FiO2 ,the 59 cases were divided into mild-moderate ARDS group(n=47)(100 mmHg<PaO2/FiO2≤300 mmHg,1 mmHg=0. 133 kPa) and severe ARDS group(n=12)(PaO2/FiO2≤100 mmHg). The cases were devided into survival group and death group according to survival situation on day 28. Forty-two cases with pneumonia were enrolled as con-trol. The data of patient demographics, clinical characteristics, cardiac function indexes, blood biochemical indicators within 6 hours after admission including H-FABP,N-terminal B-type natriuretic peptide,CK-MB, cardiactroponin-I and lactic acid,complications and survival status were collected and analyzed. The receiver operating characteristic(ROC) curve was used to evaluate the power of variables for 28-day mortality in patients with severe pneumonia complicated by ARDS. Results A total of 59 patients with severe pneumonia were enrolled in our study. The 28-day mortality rate was 20. 3％( 12/59 ) . The serum levels of H-FABP, N-terminal B-type natriuretic peptide,CK-MB and lactic acid were significantly higher in severe ARDS group [8. 8(4. 6,13. 4) ng/ml,904(209,11336)pg/ml,29. 5(19. 2,82. 5) U/L and 4. 6(1. 5,6. 1)mmol/L,re-spectively] than those in mild-moderate ARDS group,as well as control group(all P<0. 001). The serum level of H-FABP was significantly higher in the non-survivor[7. 8(4. 1,39. 7)ng/ml] than that in survivor [4. 7(3. 0,6. 0)ng/ml]with ARDS(P=0. 031). The ROC curve analysis indicated that the area under the ROC curve for H-FABP was 0. 783(95％CI 0. 532-0. 894,P <0. 05),and the optimal cut-off value for H-FABP was 6. 8 ng/ml with a sensitivity of 74. 3％ and a specificity of 87. 0％ for predicting the prognosis in patients with ARDS. Conclusion H-FABP is a sensitive indicator for prognosis in pediatric patients with severe pneumonia complicated by ARDS.