新生儿晚发型败血症导致感染性休克的危险因素分析及预测指标评价

Analysis of risk factors and evaluation of predictive indexes of septic shock caused by late-onset sepsis in neonates

目的探讨新生儿晚发型败血症(LOS)发生感染性休克的危险因素,评价不同指标对新生儿LOS发生感染性休克的预测能力。方法回顾性分析2015年1月—2019年12月在金华市中心医院儿科收治的256例LOS患儿的临床资料。根据患者是否发生感染性休克,分为感染性休克组77例和未发生感染性休克组179例,采用Logistic回归分析确定LOS患儿发生感染性休克的危险因素,并以ROC曲线预测不同指标对导致患儿感染性休克的预测能力。结果256例LOS患儿发生77例,感染性休克发生率为30.1%;极低出生体质量儿、PICC置管史、Apgar评分<7分、宫内发育迟缓及血清IL-6、PCT、LA水平增高是新生儿LOS发生感染性休克的独立危险因素(P<0.05);联合血清IL-6、PCT和LA三项指标预测发生感染性休克的ROC曲线下面积(AUC)为0.930,灵敏度为0.857,特异度为0.866,诊断效率优于单一指标。结论新生儿LOS发生感染性休克的危险因素较多,临床针对相关危险因素采取早期预防,减少LOS新生儿发生感染性休克的发生概率,降低死亡率。

Objective To explore the risk factors of septic shock in neonatal late-onset sepsis(LOS),and to evaluate the predictive ability of different indicators for neonatal LOS septic shock.Methods Retrospective analysis was performed on the clinical data of 256 children with LOS admitted to the Pediatrics Department of Jinhua Central Hospital from January 2015 to December 2019.According to whether the patients developed septic shock,they were divided into the septic shock group(77 cases)and the septic shock group(179 cases).Logistic regression analysis was used to determine the risk factors of septic shock in LOS children.ROC curve was used to predict the ability of different indicators to predict septic shock in children with LOS.Results Seventy-seven cases in 256 children suffered LOS,and the incidence of septic shock was 30.1%;very low birth weight,history of PICC catheterization,Apgar score<7,intrauterine growth retardation,serum IL-6,PCT,and elevated LA levels were independent risk factors for septic shock of neonatal LOS(P<0.05).The area under the ROC curve(AUC)of the combined serum IL-6,PCT and LA indexes for predicting the occurrence of septic shock was 0.930,the sensitivity was 0.857,and the specificity was 0.866.The diagnostic efficiency was better than that of the single index.Conclusion There are many risk factors for neonatal LOS to develop septic shock.Therefore,early prevention should be taken according to relevant risk factors in clinical practice to reduce the incidence of septic shock in neonatal LOS and reduce the mortality.