严重脓毒症患儿白蛋白水平与危重度关系研究

Clinical study on the relationship between serum albumin levels and disease severity in children with severe sepsis

目的探讨严重脓毒症患儿的低蛋白血症与其病情危重度及预后的关系。方法回顾性收集湖南省儿童医院重症监护病房(PICU)2015年6月1日至2017年6月1日住院治疗的119例严重脓毒症患儿的资料,依据入住PICU 24 h内的血清白蛋白水平分为重度低蛋白血症组(≤25 g/L),中度低蛋白血症组(~30 g/L),轻度低蛋白血症组(~35 g/L)和正常白蛋白组(>35 g/L)。分析不同白蛋白水平与其危重度及预后的变化。结果严重脓毒症患儿低蛋白血症发生率为71.43%。(1)严重脓毒症患儿白蛋白水平越低,器官衰竭数目越多,病死率越高(r=-0.457,P=0.000)。(2)单因素分析发现,随着血清白蛋白水平的降低,儿童死亡危险因素评分(PRISMⅢ)呈显著升高趋势,儿童危重病例评分(PICS)呈下降趋势;机械通气时间、入住PICU时间和住院时间均呈升高趋势。(3)多因素分析显示,白蛋白水平≤25 g/L、器官衰竭数目≥3个为严重脓毒症患儿预后的独立危险因素。结论严重脓毒症患儿血清白蛋白水平与器官衰竭数目及病情危重程度呈负相关,白蛋白水平越低,病情越严重,预后越差。

Objective To explore the relationship between hypoalbuminemia and disease severity and the prognosis in children with severe sepsis. Methods From June 1,2015 to June 1,2017,119 cases diagnosed as sepsis complicated by hypoalbuminemia by retrospective were accepted PICU admission in Hunan Provincial Children＇s Hospital. According to albumin levels in 24 h PICU admission into severe hypoalbuminemia group（≤ 25 g/L）,moderate hypoalbuminemia group（~30 g/L）,mild hypoalbuminemia group（~35 g/L）and albumin normal group（35 g/L）. To analyze the changes of the severity and prognosis of severe sepsis in children with different albumin levels. Results The incidence of hypoalbuminemia in children with severe sepsis was 71.43%.（1）For children with severe sepsis,the lower the albumin levels,the higher the number of organ failure,and the higher the mortality,It＇s negatively correlated（r=-0.457,P=0.000）.（2）Single factor analysis found that with the serum albumin levels decreasing,the PRISMⅢ score was increased,the PICS score was decreased,the mechanical ventilation time,the hospital stay and PICU stay were increased.（3）Multiple factor analysis showed that albumin level ≤ 25 g/L and MODS≥ 3 was independent risk factors for the prognosis of children with severe sepsis. Conclusion The incidence of hypoalbuminemia in patients with severe sepsis is higher. The serum albumin level was inversely associated with the number of organ failure and disease severity,the lower albumin levels,the higher the illness,the worse prognosis.