sTREM-1、Presepsin对儿童脓毒症诊断和预后评估的价值

Plasma sTREM-1 and Presepsin in diagnosis and prognostic assessment for children with sepsis

摘要:

目的 探讨可溶性髓样细胞触发受体1（sTREM-1）、Presepsin对儿童脓毒症诊断和预后评估的价值。方法 选取青海大学附属医院2019年1月—2020年12月收治的103例脓毒症患儿为脓毒症组，根据病情严重程度分为一般脓毒症组（n =48）、严重脓毒症组（n =34）及脓毒症休克组（n =21）。选取同期收治的50例普通感染患儿为感染组，40例健康体检儿童为对照组。比较各组血浆sTREM-1、Presepsin水平；采用Spearman法分析脓毒症患儿血浆sTREM-1、Presepsin水平与序贯器官衰竭（SOFA）评分的相关性；记录脓毒症患儿28 d后的预后情况，采用多因素Logistics回归分析脓毒症患儿预后不良的影响因素；绘制受试者工作特征（ROC）曲线预测血浆sTREM-1、Presepsin对脓毒症诊断和预后评估的价值。结果 脓毒症组血浆sTREM-1、Presepsin水平高于感染组和对照组，感染组高于对照组（P <0.05）。脓毒症休克组血浆sTREM-1、Presepsin水平高于一般脓毒症组和严重脓毒症组，严重脓毒症组高于一般脓毒症组（P <0.05）。Spearman相关性分析结果显示，脓毒症组血浆sTREM-1、Presepsin水平与SOFA评分呈正相关（r_s =0.434和0.412，P =0.000和0.001）。脓毒症患儿死亡28例，儿科重症监护病房时间、机械通气时间、SOFA评分、sTREM-1、Presepsin为脓毒症患儿预后不良的独立危险因素（P <0.05）。ROC曲线显示，sTREM-1+Presepsin诊断脓毒症的敏感性为82.52%（95% CI：0.738，0.893），特异性为88.00%（95% CI：0.757，0.956）；sTREM-1+Presepsin评估脓毒症患儿预后不良的敏感性为81.09%（95% CI：0.713，0.932），特异性为89.19%（95% CI：0.734，0.914）。结论 脓毒症患儿血浆sTREM-1、Presepsin水平明显升高，与脓毒症发生、发展相关，可作为脓毒症诊断与预后评估指标，联合预测价值更高。

Abstract:

Objective To investigate the value of plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and Presepsin in the diagnosis and prognostic assessment for children with sepsis.Methods Totally 103 children with sepsis admitted Qinghai University Affiliated Hospital from January 2019 to December 2020 were selected as the sepsis group, were divided into general sepsis group (n = 48), severe sepsis group (n = 34), and septic shock group (n = 21), according to the severity of the disease. 50 children with common infections admitted during the same period were selected as the infected group, and 40 healthy children examined during the same period were selected as the control group. Plasma sTREM-1 and Presepsin levels were compared among each group. Spearman correlation was used to analyze the correlation between plasma levels of sTREM-1 and Presepsin and sepsis-related organ failure assessment (SOFA) score in children with sepsis. The prognosis of children with sepsis after 28d was recorded. The multifactorial Logistic regression was used to analyze the factors influencing poor prognosis in children with sepsis, and the value of ROC curve was used to analyze the plasma sTREM-1 and Presepsin levels in the diagnosis and prognostic assessment of children with sepsis.Results Plasma sTREM-1 and Presepsin levels in sepsis group were higher than those in infection group and control group, and those in infection group were also higher than those in control group (P < 0.05). Plasma sTREM-1 and Presepsin levels in septic shock group were higher than those in general sepsis group and severe sepsis group, and those in severe sepsis group were also higher than those in general sepsis group (P < 0.05). Spearman correlation analysis showed that the levels of plasma sTREM-1 and Presepsin in sepsis group were positively correlated with SOFA score (r_s = 0.434 and 0.412, P = 0.000 and 0.001). There were 28 deaths in children with sepsis. Pediatric intensive care unit time, mechanical ventilation time, sepsis-related organ failure assessment, sTREM-1, and Presepsin were independent risk factors for poor prognosis in children with sepsis (P < 0.05). ROC curve showed that the sensitivity of sTREM-1 + Presepsin in the diagnosis of children with sepsis was 82.52% (95% CI: 0.738, 0.893), and the specificity was 88.00% (95% CI: 0.757, 0.956); the sensitivity and specificity of sTREM-1 + Presepsin in evaluating the poor prognosis of children with sepsis were 81.09% (95% CI: 0.7133, 0.932) and 89.19% (95% CI: 0.734, 0.914).Conclusion Plasma sTREM-1 and Presepsin levels are significantly elevated in children with sepsis, and correlate with the development of sepsis, and can be used as indicators for diagnostic and prognostic assessment of children with sepsis, with higher value of joint forecast.