尿胱抑素C对危重新生儿死亡的早期预测价值

Predictive value of urinary cystatin C for mortality in critically ill neonates

目的 探讨尿胱抑素C（uCys C）对危重新生儿病死率的早期预测价值.方法 选择2011年5月至2012年10月在出生6h内入住苏州大学附属儿童医院新生儿重症监护病房的新生儿为研究对象,进行前瞻性研究.根据自入院在1周内是否死亡分为死亡组和生存组（对照组）.检测患儿入院当日uCys C水平,并于入院24 h内进行新生儿急性生理学评分（SNAP）.多因素Logistic回归分析评估在校正混杂因素后uCys C与死亡的关系,用受试者工作特征曲线及曲线下面积（AUC）评估uCys C对死亡的预测价值.结果 研究期间共纳入155例新生儿,12例（7.1％）新生儿在入院1周内死亡.死亡组胎龄（t =2.810,P=0.006）、出生体质量（t=3.245,P=0.001）均显著低于对照组,uCys C（2=-3.426,P=0.001）、SNAP评分（z=-3.308,P=0.001）、机械通气（x2=23.877,P=0.000）的使用率均显著高与对照组.Logistic回归分析显示,在校正胎龄、出生体质量等因素后,uCys C水平仍与死亡显著相关.uCys C水平预测新生儿死亡的AUC值为0.81（95％ CI：0.71 ～0.92,P=0.001）;联合SNAP和机械通气后,其预测死亡的AUC为0.93（95％ CI：0.86 ～1.00,P=0.000）.结论 uCys C是新生儿死亡的独立预测指标,将其与SNAP、机械通气联合后有更好的预测价值.

Objective To determine if urinary cystatin C （uCys C） level can predict mortality in critically ill neonates.Methods This prospective study included neonates admitted to the intensive care unit within the first 6 hours of life from May.2011 to Oct.2012.Neonates were assigned into survivor and non-survivor groups based on whether they died during the first week of life.The uCys C level was measured on the day of admission.The score for neonatal acute physiology （SNAP） was calculated based on 28 items collected during the first 24 hours of admission.Multivariate Logistic regression analysis was used to determine whether uCys C level was a predictor of mortality.A receiver operating characteristic （ROC） curve was constructed and the area under the ROC curve （AUC） was calculated to assess the predictive strength.Results Of the total 155 neonates,12 cases （7.1％） died during the first week of life.When compared to survivors,the gestational age （t =2.810,P =0.006） and birth weight （t =3.245,P =0.001） in non-survivors were significantly lower; but the uCys C level （z =-3.426,P =0.001）,the SNAP score （z =-3.308,P =0.001）,and the use of mechanical ventilation （x2 =23.877,P =0.000） were significantly higher.Logistic regression analysis revealed that uCys C remained significantly associated with mortality after adjusting for gestation age,birth weight,or the SNAP score （P =0.024）.uCys C achieved AUC of 0.81 （95％ CI：0.71-0.92,P =0.001）.When combined with SNAP and mechanical ventilation,the predictive performance of uCys C improved AUC 0.93 （95 ％ CI：0.86-1.00,P =0.000）.Conclusion uCys C is significantly associated with adverse outcome of death and independently predictive of mortality in critically ill neonates.