Published online Feb 26, 2019. doi: 10.12998/wjcc.v7.i4.431
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
Sepsis is an inflammatory reaction caused by infection, and the microorganisms that cause infection are mainly bacteria. In the early stage of the disease, the clinical manifestations in children are nonspecific. However, once the inflammatory reaction is stimulated, even if the treatment is delayed several hours, the mortality of children can be significantly increased. Therefore, accurate early assessment of the prognosis of children with sepsis is the most effective way to improve the complications of children with sepsis.
There are currently no specific laboratory tests or markers that can early predict the prognosis of children with sepsis. Moreover, some clinical symptoms of children with sepsis are often similar to those of other diseases, which increases the difficulty in diagnosing sepsis. Currently, studies have shown that platelet, C-reactive protein, serum procalcitonin (PCT), serum albumin (ALB), hemoglobin scavenger receptor, and pediatric early warning score (PEWS) can assess the recovery of children with sepsis after treatment, but the children's various indicators are affected by individual and environmental changes. Therefore, the clinic needs a method to make a more accurate prediction of the complications of children with sepsis at an early stage.
The present study intended to conduct a nested case-control study to assess the value of serum markers in combination with Brighton PEWS in predicting the prognosis of children with sepsis, in order to explore whether it is a more accurate means of assessing the prognosis of children with sepsis or not.
A total of 205 children diagnosed with sepsis were enrolled. After admission, the patient began broad-spectrum antibiotic treatment and retained bacterial culture. The central venous catheter was indwelled and early rehydration was given to prevent shock. In the nested case-control study, patients who died during the study cohort were included in a study group, and children who did not die in the same cohort were defined as a control group. Baseline data, serological markers, and PEWS scores were recorded for the subjects. Conditional logistic regression was used to analyze the influencing factors of death in children with sepsis after treatment. Receiver operating characteristic (ROC) curves were established to evaluate the value of the indicators to predict the prognosis of the children.
There were 48 children each in the experimental group and the control group. Multivariate logistic regression analysis indicated that antibacterial treatments within 1 h, shock, multiple organ dysfunction syndromes (MODS), PCT, ALB, and PEWS were independent influencing factors of death in children. ROC curve analysis found that the area under the curve of the combination of ALB, PCT, and PEWS in predicting the death in children with sepsis was the highest, and the sensitivity was significantly higher than those of the three individuals. Therefore, the combination of the three indicators can reduce the impact of differences in organizational and physical compensation on the assessment results and improve the accuracy.
The present study found that antibacterial treatments within 1 h, shock, MODS, PCT, ALB, and PEWS were independent risk factors for the death of children with sepsis. The combination of PCT, ALB, and PEWS for predicting the prognosis of children with sepsis can improve the accuracy of the prediction.
The results of the study need further evaluation because the sample size was limited. However, the results suggest that PEWS score combined with serological indicators can improve the accuracy of prognosis prediction in children with sepsis, which provides useful information for the treatment of children with sepsis.