炎症因子水平联合PCIS评分对脓毒症患儿预后的评估价值

Predictive value of the levels of inflammatory factors combined with PCIS score for the prognosis of children with sepsis

目的分析炎症因子水平联合小儿危重病例评分法(PCIS)评分对脓毒症患儿预后的评估价值。方法前瞻性纳入2020年3月至2022年2月于漯河市第二人民医院接受诊治的112例脓毒症患儿作为研究对象,以入院当日起28 d存活情况评估患儿预后,分为预后不良组(28 d内病死)和预后良好组(生存超过28 d)。比较两组患儿PCIS评分、急性生理与慢性健康评分(APACHEⅡ);比较两组患儿血常规[白细胞计数(WBC)、中性粒细胞(NE)、血小板计数(PLT)]、炎症因子[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)]水平。分析炎症因子水平、PCIS评分对脓毒症患儿预后的评估效能。结果入组112例脓毒症患儿,4例符合剔除标准;剩余108例患儿纳入研究,其中自入院起28 d内32例病死(预后不良组),病死率为29.63%,其余76例纳入预后良好组。预后不良组患儿APACHEⅡ评分与CRP、PCT、IL-6水平均高于预后良好组,PCIS评分、PLT水平低于预后良好组(P<0.05)。受试者工作特征曲线结果显示,PCIS评分与CRP、PCT、IL-6水平评估脓毒症患儿预后不良风险的曲线下面积分别为0.809、0.804、0.806、0.802,四者联合的曲线下面积为0.885,评估效能最高。脓毒症患儿PCIS评分与CRP水平(r=-0.26,P=0.007)、PCT水平(r=-0.49,P<0.001)、IL-6水平(r=-0.22,P=0.020)均呈负相关性。结论脓毒症患儿预后不良与PCIS评分降低,CRP、PCT、IL-6表达升高有关。CRP、PCT、IL-6水平与PCIS评分联合能够作为脓毒症患儿预后不良风险的评估指标。

Objective To analyze the efficacy of the levels of inflammatory factors combined with pediatric critical illness score(PCIS)in evaluating the prognosis of children with sepsis.Methods A total of 112 children with sepsis who were diagnosed and treated in Luohe Second People’s Hospital from March 2020 to February 2022 were prospectively included as the research object.The prognosis of the children was evaluated based on the survival condition within 28 days after the day of admission,and they were divided into poor prognosis group(dead within 28 days)and good prognosis group(survival over 28 days).The PCIS score and acute physiology and chronic health score(APACHEⅡ)of children were evaluate.The blood routine examination indexes,including white blood cell(WBC),neutrophil(NE)and platelet(PLT),levels of inflammatory factors,including C-reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6),of the children were detected.The efficiency of inflammatory factors and PCIS score in evaluation on the prognosis of children with sepsis was analyzed.Results Of the 112 children with sepsis in the study,4 children met the exclusion criteria.The remaining 108 children were enrolled in the study,of which 32 cases dead(poor prognosis group)within 28 days after admission,with a fatality rate of 29.63%;and the rest 76 cases were allocated into good prognosis group.The APACHEⅡscore,CRP,PCT and IL-6 of the poor prognosis group were higher than those of the good prognosis group,however,PCIS score and PLT of the poor prognosis group were lower than those of the good prognosis group(P<0.05).The results of receiver operating characteristic curve showed that area under the curve of PCIS score,CRP,PCT,IL-6 in evaluating risk of poor prognosis in children with sepsis were 0.809,0.804,0.806,0.802,respectively,and area under the curve of the combination of the four indexes was 0.885,suggesting best efficiency.PCIS score was negatively correlated with CRP(r=-0.26,P=0.007),PCT(r=-0.49,P<0.001)and IL-6(r=-0.22,P=0.020)in children with sepsis.Conclusions The poor prognosis of children with sepsis is related to the decrease of PCIS score and the increase of CRP,PCT,IL-6 expression.The combined determination of CRP,PCT,IL-6 and PCIS score can be used as indexes to evaluate the poor prognosis risk of children with sepsis.