PDW、MPV、Lac及小儿危重症评分对儿童脓毒性休克的预测价值

The predictive values of PDW,MPV,Lac and pediatric critical illness score for children with septic shock

目的 探讨血小板平均体积(MPV)、血小板分布宽度(PDW)、乳酸(Lac)、小儿危重症评分(PCIS)对儿童脓毒性休克的预测价值。方法 回顾性选取该院儿童重症救护中心(PICU)2018年3月至2021年3月收治的140例脓毒症患儿。根据患儿脓毒症是否进展为脓毒性休克,将这140例患儿分为脓毒症组(83例)与脓毒性休克组(57例)。比较两组患儿的一般资料及相关实验室检测指标。采用多因素Logistic回归分析患儿的脓毒症进展为脓毒性休克的影响因素。绘制受试者工作特性(ROC)曲线,分析C反应蛋白(CRP)、Lac、MPV、血小板(PLT)等指标对脓毒性休克的预测效能。结果 脓毒症组和脓毒性休克组比较,年龄、性别、白细胞计数、血红蛋白、PLT、清蛋白、PDW、CRP、降钙素原差异均无统计学意义(P>0.05)。脓毒性休克组血清肌酐(Scr)、MPV、Lac均高于脓毒症组,PCSI评分低于脓毒症组(P<0.05)。多因素Logistic回归分析显示,PLT、Scr、MPV、CRP、Lac是患儿的脓毒症进展为脓毒性休克的独立影响因素(P<0.05)。ROC曲线分析显示,MPV预测儿童脓毒性休克的曲线下面积(AUC)最大,为0.752,Lac次之,为0.707,但后者灵敏度最高,为82.46%,特异度为57.83%。结论 MPV是预测儿童脓毒性休克的有效指标,较PDW、CRP、Lac及PLT等传统指标更有优势。

Objective To investigate the predictive value of mean platelet volume(MPV),platelet distribution width(PDW),lactic acid(Lac)and pediatric critical illness score(PCIS)for children with septic shock.Methods A total of 140 children with sepsis admitted to the pediatric intensive care unit of the hospital from March 2018 to March 2021 were retrospectively selected.According to whether the children with sepsis developed into septic shock,the 140 children were divided into sepsis group(83 cases)and septic shock group(57 cases).The two groups were compared in terms of general data and related laboratory test indicators.Multivariate Logistic regression was used to analyze the influencing factors of septic shock in children with sepsis.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of C-reactive protein(CRP),Lac,MPV,platelet(PLT)and other indicators for septic shock.Results There were no significant differences in age,gender,white blood cell count,hemoglobin,platelet,albumin,PDW,CRP,and procalcitonin between the sepsis group and the septic shock group(P>0.05).Compared with the sepsis group,the septic shock group had significantly higher serum creatinine(Scr),MPV,and Lac and a significantly lower PCSI score(P<0.05).Multivariate Logistic regression analysis showed that PLT,Scr,MPV,CRP,and Lac were independent influencing factors for the development of septic shock in children with sepsis(P<0.05).ROC curve analysis showed that MPV had the largest AUC(0.752)for predicting septic shock in children,followed by Lac(0.707),but the latter one had the highest sensitivity(82.46%)and specificity(57.83%).Conclusion MPV is an effective indicator for predicting septic shock in children,which has more advantages than PDW,CRP,Lac and PLT.