脓毒症合并凝血功能障碍患儿近期预后不良的危险因素

Risk Factors for Poor Short-Term Prognosis in Children with Sepsis Combined with Coagulopathy

目的分析脓毒症合并凝血功能障碍患儿近期预后不良危险因素。方法回顾性选取郑州大学第一附属医院2021年9月至2023年8月收治的226例脓毒症合并凝血功能障碍患儿临床资料作为研究对象,根据患儿28 d预后情况分为预后不良组(34例)和预后良好组(192例)。比较两组一般资料及各项指标,筛选预后不良危险因素,评价各危险因素对预后不良预测价值。结果预后不良组血清纤维蛋白原(Fib)、抗凝血酶Ⅲ(AT-Ⅲ)水平低于预后良好组,急性生理与慢性健康状况评分系统(APACHEⅡ)分值高于预后良好组(P<0.05);Fib、AT-Ⅲ是脓毒症合并凝血功能障碍近期预后不良的保护因素,APACHEⅡ是脓毒症合并凝血功能障碍近期预后不良的独立危险因素(P<0.05);Fib、APACHEⅡ、AT-Ⅲ联合预测脓毒症合并凝血功能障碍患儿近期预后不良的曲线下面积(AUC)值高于Fib、APACHEⅡ、AT-Ⅲ单项预测(P<0.05);Kaplan-Meier曲线显示,Fib>1.67 g·L^(-1)、APACHEⅡ≤13.00分、AT-Ⅲ>38.56%患儿生存时间均长于Fib≤1.67 g·L^(-1)、APACHEⅡ>13.00分、AT-Ⅲ≤38.56%患儿(P<0.05)。结论Fib、AT-Ⅲ是脓毒症合并凝血功能障碍近期预后不良保护因素,APACHEⅡ是脓毒症合并凝血功能障碍近期预后不良的危险因素,各指标联合预测脓毒症合并凝血功能障碍近期预后不良价值好,临床可应用推广。

Objective To analyze short-term risk factors for poor prognosis in children with sepsis combined with coagulation disorders.Methods The clinical data of 226 children with sepsis combined with coagulation dysfunction admitted to the First Affiliated Hospital of Zhengzhou University were retrospectively selected as the study subjects from September 2021 to August 2023,and the children were divided into a poor prognosis group(34 cases)and a good prognosis group(192 cases)according to their 28 days prognosis.General information and indicators were compared between the two groups,risk factors for poor prognosis were screened,and the predictive value of each risk factor for poor prognosis was evaluated.Results Serum fibrinogen(Fib)and antithrombinⅢ(AT-Ⅲ)levels were lower in the poor prognosis group than those in the good prognosis group,and acute physiology and chronic health evaluation(APACHEⅡ)scores were higher than those in the good prognosis group(P<0.05).Fib,AT-Ⅲwere protective factors for poor short-term prognosis of sepsis-combined coagulation dysfunction,and APACHEⅡwas an dysfunction independent risk factor for poor short-term prognosis(P<0.05).The area under the curve(AUC)values of Fib,APACHEⅡ,and AT-Ⅲcombined to predict poor short-term prognosis in children with sepsis combined with coagulation dysfunction were higher than those predicted by Fib,APACHEII,and AT-Ⅲalone(P<0.05).Kaplan-Meier curves showed that the survival time of children with Fib>1.67 g·L^(-1),APACHEⅡ≤13.00 points,and AT-Ⅲ>38.56%were longer than that of children with Fib≤1.67 g·L^(-1),APACHEⅡ>13.00 points,and AT-Ⅲ≤38.56%(P<0.05).Conclusion Fib and AT-Ⅲare protective factors for short-term poor prognosis of sepsis-combined coagulation dysfunction,and APACHEⅡis a risk factor for short-term poor prognosis of sepsis-combined coagulation dysfunction,and the combination of all the indexes to predict the short-term poor prognosis of sepsis-combined coagulation dysfunction is of good value,and it can be applied to promote the clinical application.