脓毒症患儿相关标志物水平与小儿危重病例评分及小儿死亡危险因素评分的相关性

Correlation between the levels of relevant markers in children with sepsis and the pediatric critical case scores and the pediatric risk factor scores for mortality

目的探讨脓毒症患儿相关标志物水平与小儿危重病例评分(PCIS)及小儿死亡危险因素评分(PRISMⅢ)的相关性。方法回顾性分析2020年5月—2022年5月在本院儿童重症监护病房收治的99例脓毒症患儿的临床资料,分析90例存活组和9例死亡组患儿白细胞计数(WBC)、中性粒细胞与淋巴细胞比值(NLR)、48 h NLR、NLR变化率、平均血小板体积(MPV)、血小板体积分布宽度(PDW)和PCIS、PRISMⅢ评分的相关性;绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),比较NLR、NLR变化率、MPV、PDW对患者的28 d全因死亡风险预测价值。结果与存活组比较,死亡组48 h NLR、NLR变化率、MPV、PDW水平及PRISMⅢ分数均较存活组升高,PCIS分数降低(P<0.05)。48 h NLR、NLR变化率、MPV、PDW与PRISMⅢ分数成正相关性(r值为0.117~0.265,P<0.05);而48 h NLR、NLR变化率与PCIS分数成负相关性(r值分别为-0.323、-0.342,P<0.05)。各指标评价脓毒症患儿预后的曲线下面积(AUC)从高到低依次为MPV、48 h NLR、PRISMⅢ分数、PCIS分数、PDW、NLR变化率。结论MPV和48 h NLR可能是评估脓毒症患儿病情严重程度和预测疾病预后的潜在指标。

Objective This paper aims to investigate the correlation between the levels of relevant markers and pediatric critical case score(PCIS)and pediatric risk factor score for mortality(PRISMⅢ)in children with sepsis.Methods Retrospective analysis was conducted on the clinical data of 99 children with sepsis admitted to our pediatric intensive care unit from May 2020 to May 2022,and analysis was performed on the correlations of PCIS and PRISM Ⅲ with white blood cell count(WBC),neutrophil-to-lymphocyte ratio(NLR),48 h NLR,NLR change rate,mean platelet volume(MPV),platelet volume distribution width(PDW)in 90 children in the survival group and 9 children in the death group.Receiver operating characteristic(ROC)curves were plotted and the area under the curve(AUC)was calculated to compare the predictive value of NLR,NLR rate of change,MPV and PDW on the risk of all-cause mortality at 28 d.Results Compared with the surviving group,the 48 h NLR,NLR rate of change,MPV,PDW levels and PRISM Ⅲ score were increased and the PCIS score was decreased in the death group compared with the surviving group(P<0.05).48 h NLR,NLR rate of change,MPV,PDW and PRISM Ⅲ score were positively correlated(r=0.117-0.265,P<0.05);while 48 h NLR and NLR change rate were negatively correlated with PCIS scores(r=-0.323,-0.342,P<0.05).The area under the curve(AUC)of each index to evaluate the prognosis of children with sepsis was MPV,48 h NLR,PRISM Ⅲ score,PCIS score,PDW,and NLR rate of change in descending order.Conclusion MPV and 48 h NLR may be potential indicators for assessing disease severity and predicting disease prognosis in children with sepsis.