Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2019; 7(4): 431-440
Published online Feb 26, 2019. doi: 10.12998/wjcc.v7.i4.431
Nested case-control study of multiple serological indexes and Brighton pediatric early warming score in predicting death of children with sepsis
Xiong Xie, Ming Li, Tian-Tian Xiong, Rui Wang, Liang Xiao
Xiong Xie, Ming Li, Tian-tian Xiong, Rui Wang, Liang Xiao, Department of Pediatrics, Third Clinical Hospital, China Three Gorges University, Gezhouba Central Hospital, Yichang 443002, Hubei Province, China
Author contributions: Xie X, Li M, and Xiong TT designed the research; Xie X, Li M, and Wang R performed the research; Xiao L and Wang R contributed new reagents; Xie X, Li M, and Xiong TT analyzed the data; and Xie X, Li M, Xiong TT, Wang R, and Xiao L wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Gezhouba Group Central Hospital.
Informed consent statement: All patients gave informed consent to this study.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ming Li, MD, Doctor, Department of Pediatrics, Third Clinical Hospital, China Three Gorges University, Gezhouba Central Hospital, No. 60, Qiaohu No. 1 Road, Yichang 443002, Hubei Province, China. 150501028@qq.com
Telephone: +86-717-6715660
Received: November 27, 2018
Peer-review started: November 27, 2018
First decision: December 15, 2018
Revised: December 25, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: February 26, 2019
Processing time: 92 Days and 1.7 Hours
Abstract
BACKGROUND

Currently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score (PEWS) is a disease risk assessment system that is simple and easy to operate, which has good sensitivity and specificity in disease recognition among children. Because detection indicators vary widely in children, a single indicator is difficult to assess the post-treatment status of children with sepsis.

AIM

To investigate the relationship between serological markers, Brighton PEWS, and death in children with sepsis after treatment.

METHODS

A total of 205 children diagnosed with sepsis at our hospital were enrolled. The baseline data, serum scores, and PEWS scores were recorded. In the nested case-control study, children who died during the study period were included in an observation group. According to the matching principle, the children who were not dead in the same cohort were included in a control group. The influencing factors of death in children with sepsis after treatment and the value of each evaluation index in predicting the prognosis of children were analyzed.

RESULTS

A total of 96 children were enrolled in the study, including 48 each in the observation group and the control group. Multivariate logistic regression analysis indicated that antibacterial treatments within 1 h (P = 0.017), shock (P = 0.044), multiple organ dysfunction syndrome (MODS) (P = 0.027), serum procalcitonin (PCT) (P = 0.047), serum albumin (ALB) (P = 0.024), and PEWS (P = 0.012) were independent risk factors for the death of children with sepsis. The area under the curve of the combination of ALB, PCT, and PEWS to predict the death in children with sepsis was the highest (0.908).

CONCLUSION

Antibacterial treatments within 1 h, shock, MODS, PCT, ALB, and PEWS are independent risk factors for the death of children with sepsis. The predictive accuracy of the combination of PCT, ALB, and PEWS for the prognosis of children with sepsis is the best.

Keywords: Serological indicators; Pediatric early warming score; Sepsis; Nested case-control study; Systemic inflammatory reaction syndrome

Core tip: Currently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score (PEWS) is a risk assessment system that is simple and easy to operate, which has good sensitivity and specificity in disease recognition among children. In this study, the nested case-control study found that the use of antimicrobial agents within 1 h, shock, number of organs with dysfunction, serum procalcitonin (PCT), serum albumin (ALB), and PEWS were independent risk factors for death of children with sepsis. The combination of ALB, PCT, and PEWS can predict the prognosis of children with sepsis with good accuracy and can improve the sensitivity of prediction.