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Predictive value of laboratory indicators for in-hospital death in children with community-onset sepsis: a prospective observational study of 266 patients.
Liu, Jing; Hui, Qin; Lu, Xiuxiu; Li, Wei; Li, Ning; Chen, Yuanmei; Zhang, Qi.
Afiliação
  • Liu J; Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.
  • Hui Q; Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
  • Lu X; Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.
  • Li W; Department of Intensive Care Unit, Capital Institute of Pediatrics, Beijing, China.
  • Li N; Department of Intensive Care Unit, Capital Institute of Pediatrics, Beijing, China.
  • Chen Y; Department of Intensive Care Unit, Capital Institute of Pediatrics, Beijing, China.
  • Zhang Q; Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.
BMJ Paediatr Open ; 8(1)2024 May 15.
Article em En | MEDLINE | ID: mdl-38754894
ABSTRACT
BACKGROUND AND

OBJECTIVES:

This study aimed to identify predictors of sepsis-associated in-hospital mortality from readily available laboratory biomarkers at onset of illness that include haematological, coagulation, liver and kidney function, blood lipid, cardiac enzymes and arterial blood gas.

METHODS:

Children with sepsis were enrolled consecutively in a prospective observational study involving paediatric intensive care units (PICUs) of two hospitals in Beijing, between November 2016 and January 2020. The data on demographics, laboratory examinations during the first 24 hours after PICU admission, complications and outcomes were collected. We screened baseline laboratory indicators using the Least Absolute Shrinkage and Selection Operator (LASSO) analysis, then we constructed a mortality risk model using Cox proportional hazards regression analysis. The ability of risk factors to predict in-hospital mortality was evaluated by receiver operating characteristic (ROC) curves.

RESULTS:

A total of 266 subjects were enrolled including 44 (16.5%) deaths and 222 (83.5%) survivors. Those who died showed a shorter length of hospitalisation, and a higher proportion of mechanical ventilation, complications and organ failure (p<0.05). LASSO analysis identified 13 clinical parameters related to prognosis, which were included in the final Cox model. An elevated triglyceride (TG) remained the most significant risk factor of death (HR=1.469, 95% CI 1.010 to 2.136, p=0.044), followed by base excess (BE) (HR=1.131, 95% CI 1.046 to 1.223, p=0.002) and pH (HR=0.95, 95% CI 0.93 to 0.97, p<0.001). The results of the ROC curve showed that combined diagnosis of the three indicators-TG+BE+pH-has the best area under the curve (AUC) (AUC=0.77, 95% CI 0.69 to 0.85, p<0.001), with a 68% sensitivity and 80% specificity.

CONCLUSION:

Laboratory factors of TG, BE and pH during the first 24 hours after intensive care unit admission are associated with in-hospital mortality in PICU patients with sepsis. The combination of the three indices has high diagnostic value.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Biomarcadores / Unidades de Terapia Intensiva Pediátrica / Mortalidade Hospitalar / Sepse Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Biomarcadores / Unidades de Terapia Intensiva Pediátrica / Mortalidade Hospitalar / Sepse Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Ano de publicação: 2024 Tipo de documento: Article