血清PCT、ALB、PSP联合预测脓毒症患儿预后的临床价值

Clinical value of serum PCT,ALB and PSP in predicting the prognosis of sepsis in children

目的探究血清降钙素原(procalcitonin,PCT)、白蛋白(albumin,ALB)、胰石蛋白(pancreatic stone protein,PSP)联合预测脓毒症患儿预后的临床价值。方法选取脓毒症患儿322例为研究对象,根据患儿病情严重程度分为脓毒症组126例、严重脓毒症组105例、脓毒性休克组91例,另选取健康儿童80例为对照组。比较各组血清PCT、ALB及PSP水平,分析脓毒症患儿预后的相关影响因素,应用ROC曲线评估PCT、ALB及PSP对脓毒症患儿预后的预测价值。结果4组血清PCT、ALB及PSP水平比较差异有统计学意义(P<0.05);脓毒症组PCT、PSP水平高于对照组,ALB水平低于对照组,严重脓毒症组PCT、PSP水平高于脓毒症组和对照组,ALB水平低于脓毒症组和对照组,脓毒性休克组PCT、PSP水平高于严重脓毒症组、脓毒症组和对照组,ALB水平低于严重脓毒症组、脓毒症组和对照组,差异有统计学意义(P<0.05)。随访28 d,322例患儿中死亡48例(14.91%),存活274例(85.09%)。严重脓毒症组病死率高于脓毒症组,脓毒性休克组病死率高于脓毒症组和严重脓毒症组,差异有统计学意义(P<0.01)。死亡组PCT和PSP水平高于存活组,ALB水平和PCIS评分低于存活组,差异有统计学意义(P<0.05)。多因素Logistic回归分析,结果显示,血清PCT、ALB、PSP及PCIS评分是脓毒症患儿死亡的危险因素(P<0.05)。ROC曲线显示,血清PCT、ALB、PSP对脓毒症患儿死亡具有一定预测价值(曲线下面积,area under curve,AUC=0.741、0.783、0.784,P<0.01),三项联合的敏感度、特异度为87.5%、91.6%,预测价值较高(AUC=0.953,P<0.01)。结论血清PCT、ABL、PSP水平对脓毒症患儿预后均有一定的预测价值,三者者联合预测的特异度、敏感度较高,对预后的预测更加准确,临床可加强监测。

Objective To explore the clinical value of serum procalcitonin(PCT),albumin(ALB),and pancreatic stone protein(PSP)in diagnosing sepsis.Methods A total of 322 children with sepsis were selected as the study subjects.According to the severity of the disease,the children were divided into the sepsis group(126 cases),the severe sepsis group(105 cases),and the septic shock group(91 cases).Another 80 healthy children were selected as the control group.Serum PCT,ALB and PSP levels were compared in each group to analyze the relevant influencing factors for the prognosis of children with sepsis,and the predictive value of PCT,ALB and PSP for the prognosis of children with sepsis was evaluated by ROC curve.Results There were statistically significant differences in serum PCT,ALB and PSP levels among 4 groups(P<0.05).PCT,PSP levels of sepsis group were higher than the control group,propagated level was lower than the control group.PCT,PSP levels of severe sepsis group were higher than that of sepsis group and the control group,propagated level below the sepsis group and the control group,PCT,PSP levels of septic shock group were higher than that of severe sepsis group,sepsis group and the control group,propagated levels below severe sepsis,sepsis group and the control group,the difference was statistically significant(P<0.05).After 28 days of follow-up,48 of the 322 children died(14.91%)and 274 survived(85.09%).The mortality of the severe sepsis group was higher than that of the sepsis group,and the mortality of the septic shock group was higher than that of the sepsis group and the severe sepsis group,and the difference was statistically significant(P<0.01).PCT and PSP levels in the death group were higher than those in the survival group,ALB levels and PCIS scores were lower than those in the survival group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that serum PCT,ALB,PSP and PCIS scores were risk factors for death in children with sepsis(P<0.05).ROC curve showed that serum PCT,ALB and PSP had certain predictive value for the death of children with sepsis(area under the curve,Area under curve,AUC=0.741,0.783,0.784,P<0.01),the sensitivity and specificity of the three combinations were 87.5%and 91.6%,with high predictive value(AUC=0.953,P<0.01).Conclusion Serum PCT,ABL and PSP levels are of certain predictive value for the prognosis of children with sepsis,and the combined prediction of the three levels has high specificity and sensitivity,which makes the prediction of prognosis more accurate and clinical monitoring can be strengthened.