Effect of pSOFA score combined with C-reactive protein and procalcitonin in prognosis assessment of sepsis children

doi:10.3969/j.issn.1004-583X.2022.07.006

Abstract

Abstract:

Objective To evaluat pediatric sequential organ failureassessment (pSOFA) score combined with C-reactive protein (CRP), procalcitonin (PCT), and other infection-related biomarkers of the prognostic assessment in sepsis children. Methods A retrospective observational study was applied to collect the clinical data of 289 sepsis children (2018.8-2019.8) admitted to Pediatric Intensive Care Unit (PICU) of the Hospital. The children were divided into the survival group and death group according to 28-day survival outcomes. The differences in intergroup physiological and laboratory data in pediatric intensive care unit (PICU) within 24 hours of admission were compared, binary logistic regression was applied to analyze high-risk factors impacting the prognosis of sepsis children, the receiver operating characteristic (ROC) curve and the area under ROC curve (AUC) were drawn to assess the effects of the pSOFA scores combined with CRP and PCT in the early diagnosis and prognosis of children with sepsis. Results A total of 289 children including 254 (87.9%) in the survival group and 35 (12.1%) in the death group were included in the study. The comparative differences of children in terms of availability of constantly pumped vasoactive drugs, duration of mechanical ventilation, Glasgow coma scores, gastrointestinal functions, and serum PCT concentration were statistically significant (all P<0.05). Binary logistic regression showed that pSOFA scores and availability of continuously pumped vasoactive drugs were high-risk factors for poor prognosis in children with sepsis (P<0.05); AUCs for CRP and PCT to predict death in children with sepsis was 0.547(95%CI: 0.488-0.606) and 0.667(95%CI: 0.609-0.721), respectively. The AUC of pSOFA+CRP, pSOFA+PCT and pSOFA scores for predicting death of children with sepsis was 0.947 without exception (95%CI: 0.914-0.970), and the differences weren't statistically significant (P>0.05). Conclusion pSOFA scores deliver important value for prognostic evaluation of sepsis children, while pSOFA score combined with CRP and PCT fail to improve the prognostic evaluation of children with sepsis.

Key words: sepsis, pediatrics, pSOFA score, C-reactive protein, procalcitonin, prognosis

CLC Number:

R631

Zhou Bin, Zeng Cizheng, Huang Yuge, Zhong Mianling, Wu Jiayuan. Effect of pSOFA score combined with C-reactive protein and procalcitonin in prognosis assessment of sepsis children[J]. Clinical Focus, 2022, 37(7): 616-622.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.07.006

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I7/616

Figures/Tables 8

项目	存活组	死亡组	χ²/ $Z$ 值	$P$ 值
例数	254	35
男/女	165/89	23/12	0.008	0.930
年龄[月, $M$ (P25,P75)]	5.5[2.0,22.3]	17.0[6.0,53.0]	3.388	0.001
PICU住院时间(d, $x -$ ±s)	6.6±7.2	8.4±13.4	-1.142	0.215
总住院时间(d, $x -$ ±s)	12.8±9.7	9.0±16.3	1.352	0.185
机械通气时间(d, $x -$ ±s)	1.1±4.9	4.0±4.7	-3.448	0.001
持续泵入血管活性药物[例(%)]	57(22.4)	32(91.4)	68.695	0.000
胃肠功能(正常/肠麻痹/肠出血)[例(%)]	250(98.4)/3(1.2)/1(0.4)	27(77.1)/8(22.9)/0	23.463	0.000
格拉斯哥昏迷评分[分,M(P25,P75)]	13[13,13]	5[3,10]	-9.948	0.000
CRP[mg/L, $M$ (P25,P75)]	6.9[2.9,20.8]	8.1[3.7,72.7]	0.904	0.366
PCT[ng/L, $M$ (P25,P75)]	0.3[0.1,1.7]	1.6[0.4,20.5]	3.196	0.001
pSOFA(分, $x -$ ±s)	3.0±2.4	10.6±3.9	-11.137	0.000

项目	存活组	死亡组	χ²/ $Z$ 值	$P$ 值
例数	254	35
男/女	165/89	23/12	0.008	0.930
年龄[月, $M$ (P25,P75)]	5.5[2.0,22.3]	17.0[6.0,53.0]	3.388	0.001
PICU住院时间(d, $x -$ ±s)	6.6±7.2	8.4±13.4	-1.142	0.215
总住院时间(d, $x -$ ±s)	12.8±9.7	9.0±16.3	1.352	0.185
机械通气时间(d, $x -$ ±s)	1.1±4.9	4.0±4.7	-3.448	0.001
持续泵入血管活性药物[例(%)]	57(22.4)	32(91.4)	68.695	0.000
胃肠功能(正常/肠麻痹/肠出血)[例(%)]	250(98.4)/3(1.2)/1(0.4)	27(77.1)/8(22.9)/0	23.463	0.000
格拉斯哥昏迷评分[分,M(P25,P75)]	13[13,13]	5[3,10]	-9.948	0.000
CRP[mg/L, $M$ (P25,P75)]	6.9[2.9,20.8]	8.1[3.7,72.7]	0.904	0.366
PCT[ng/L, $M$ (P25,P75)]	0.3[0.1,1.7]	1.6[0.4,20.5]	3.196	0.001
pSOFA(分, $x -$ ±s)	3.0±2.4	10.6±3.9	-11.137	0.000

影响因素	回归系数	标准误	Wald χ²值	$O R$ 值	95% $C I$	$P$ 值
年龄	0.015	0.009	2.938	1.015	0.998-1.033	0.087
机械通气时间	-0.070	0.047	2.267	0.932	0.851-1.021	0.132
是否持续静脉泵入血管活性药物	-1.756	0.804	4.772	0.173	0.036-0.835	0.029
格拉斯哥昏迷评分	-0.186	0.097	3.718	0.830	0.687-1.003	0.054
胃肠功能	0.371	1.972	0.106	1.372	0.204-9.216	0.745
CRP	0.007	0.005	1.686	1.007	0.997-1.017	0.194
PCT	-0.015	0.013	1.477	0.985	0.961-1.009	0.224
pSOFA评分	0.371	0.105	12.394	1.449	1.179-1.782	0.000

影响因素	回归系数	标准误	Wald χ²值	$O R$ 值	95% $C I$	$P$ 值
年龄	0.015	0.009	2.938	1.015	0.998-1.033	0.087
机械通气时间	-0.070	0.047	2.267	0.932	0.851-1.021	0.132
是否持续静脉泵入血管活性药物	-1.756	0.804	4.772	0.173	0.036-0.835	0.029
格拉斯哥昏迷评分	-0.186	0.097	3.718	0.830	0.687-1.003	0.054
胃肠功能	0.371	1.972	0.106	1.372	0.204-9.216	0.745
CRP	0.007	0.005	1.686	1.007	0.997-1.017	0.194
PCT	-0.015	0.013	1.477	0.985	0.961-1.009	0.224
pSOFA评分	0.371	0.105	12.394	1.449	1.179-1.782	0.000

评分系统	AUC	95% $C I$	最佳截断值	敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	$Z$ 值	$P$ 值
CRP	0.547	0.488-0.606	>91.5	22.86	90.94	2.52	0.85	0.839	0.4016
PCT	0.667	0.609-0.721	>0.891	68.57	67.32	2.10	0.47	2.953	0.0031
pSOFA	0.947	0.914-0.970	>5	85.71	88.19	7.26	0.16	28.149	<0.0001
pSOFA+CRP	0.947	0.914-0.970	>0.071	85.71	88.19	7.26	0.16	28.149	<0.0001
pSOFA+PCT	0.947	0.914-0.970	>0.071	85.71	88.19	7.26	0.16	28.149	<0.0001

评分系统	AUC	95% $C I$	最佳截断值	敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	$Z$ 值	$P$ 值
CRP	0.547	0.488-0.606	>91.5	22.86	90.94	2.52	0.85	0.839	0.4016
PCT	0.667	0.609-0.721	>0.891	68.57	67.32	2.10	0.47	2.953	0.0031
pSOFA	0.947	0.914-0.970	>5	85.71	88.19	7.26	0.16	28.149	<0.0001
pSOFA+CRP	0.947	0.914-0.970	>0.071	85.71	88.19	7.26	0.16	28.149	<0.0001
pSOFA+PCT	0.947	0.914-0.970	>0.071	85.71	88.19	7.26	0.16	28.149	<0.0001

评分系统	AUC	95% $C I$	最佳截断值	敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	$Z$ 值	$P$ 值
CRP	0.601	0.538-0.662	>19.3	48.84	76.67	2.09	0.67	1.831	0.0671
PCT	0.684	0.623-0.741	>1.01	62.79	76.19	2.64	0.49	3.660	0.0003
pSOFA	0.904	0.861-0.937	>4	74.42	90.48	7.81	0.28	16.53	<0.0001
pSOFA+CRP	0.911	0.869-0.943	>0.2861	79.07	90.48	8.30	0.23	15.451	<0.0001
pSOFA+PCT	0.913	0.872-0.945	>0.2342	79.07	89.52	7.55	0.23	16.340	<0.0001

评分系统	AUC	95% $C I$	最佳截断值	敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	$Z$ 值	$P$ 值
CRP	0.601	0.538-0.662	>19.3	48.84	76.67	2.09	0.67	1.831	0.0671
PCT	0.684	0.623-0.741	>1.01	62.79	76.19	2.64	0.49	3.660	0.0003
pSOFA	0.904	0.861-0.937	>4	74.42	90.48	7.81	0.28	16.53	<0.0001
pSOFA+CRP	0.911	0.869-0.943	>0.2861	79.07	90.48	8.30	0.23	15.451	<0.0001
pSOFA+PCT	0.913	0.872-0.945	>0.2342	79.07	89.52	7.55	0.23	16.340	<0.0001

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