CgA、TNF-α、IL-6联合改良qSOFA评分在儿童脓毒症预后评估中的应用价值

Application of combined measurement of CgA,TNF-α,IL-6,and modified qSOFA score in the prognostic assessment of pediatric sepsis

目的探究嗜铬粒蛋白A(chromogranin A,CgA)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)联合改良快速序贯器官衰竭评分(qSOFA)在儿童脓毒症预后评估中的应用价值。方法选取2020年3月至2023年4月收治的脓毒症患儿的临床资料,共188例。根据患儿的病情严重程度将其分为脓毒症组(n=113)和严重脓毒症组(n=75)。比较两组患儿的CgA、TNF-α、IL-6水平。分析CgA、TNF-α、IL-6水平及改良qSOFA评分与患儿预后的关系,探究其对患儿预后的预测价值。结果严重脓毒症组患儿的CgA、TNF-α、IL-6及改良qSOFA评分高于脓毒症组(P<0.05)。死亡组患儿的CgA、TNF-α、IL-6及改良qSOFA评分比生存组更高(P<0.05)。以患儿的预后情况为自变量(生存=0,死亡=1),对患儿的CgA、TNF-α、IL-6及改良qSOFA评分进行多因素logistic回归分析,可知上述指标均会对患儿的预后情况产生影响(P<0.05)。采用受试者工作特征(ROC)曲线探究CgA、TNF-α、IL-6及改良qSOFA评分对患者预后不良的预测价值,其AUC值分别为0.926、0.875、0.863、0.862,联合应用的AUC值为0.994,高于各指标分别预测(P<0.05)。结论CgA、TNF-α、IL-6联合改良qSOFA评分在严重脓毒症患儿及死亡患儿中显著升高,且其联合应用对患儿预后不良的预测价值较高,可以辅助患儿的临床治疗。

Objective To evaluate the application of combined measurement of chromogranin A(CgA),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and modified quick Sequential Organ Failure Assessment(qSOFA)score in the prognostic assessment of pediatric sepsis.Methods Clinical data of 188 pediatric sepsis patients admitted to our hospital from March 2020 to April 2023 were selected.The patients were divided into sepsis group(n=113)and severe sepsis group(n=75)based on the severity of their condition.CgA,TNF-α,and IL-6 levels were compared between the two groups.The relationship between CgA,TNF-α,IL-6 levels,modified qSOFA score,and the prognosis of children was analyzed to explore their predictive value for the prognosis of children.Results CgA,TNF-α,IL-6,and modified qSOFA scores in the severe sepsis group were higher than those in the sepsis group(P<0.05).Patients in the deceased group had higher CgA,TNF-α,IL-6,and modified qSOFA scores compared to the survival group(P<0.05).Using the prognosis of children as the independent variable(survival=0,death=1),multiple logistic regression analysis of CgA,TNF-α,IL-6,and modified qSOFA scores showed that these indicators would impact the prognosis of children(P<0.05).The AUC values of receiver operating characteristic(ROC)curves for predicting adverse prognosis in patients using CgA,TNF-α,IL-6,and modified qSOFA scores were 0.926,0.875,0.863,0.862,respectively.The AUC value of combined application was 0.994,higher than individual predictions(P<0.05).Conclusion Combined measurement of CgA,TNF-α,IL-6,and modified qSOFA scores significantly increases in pediatric patients with severe sepsis and deceased patients.Their combined application has a high predictive value for adverse prognosis in children,assisting in the clinical treatment of pediatric sepsis.