Endocan Levels Are Predictive Of Acute Lung Injury In Children With Sepsis

ObjectiveSepsis is multiple organ dysfunction caused by disorder of host response to infection.Among them,the lung is often the first organ to fail.The first clinical manifestation is acute lung injury(ALI).At present,the early diagnosis indexes of ALI are lack of sensitivity and specificity.Endocan,as a soluble proteoglycan,is mainly secreted by pulmonary vascular endothelial cells under the condition of promoting inflammation,and a few can also be secreted by renal vascular endothelial cells.It is biological function can inhibit the adhesion between leukocytes and endothelial cells,prevent the migration of leukocytes to lung tissue,and play a potential anti-inflammatory role in ALI caused by sepsis.The purpose of this study is to analyze the predictive value of endocan level in serum and Bronchoalveolar lavage fluid(BALF)for ALI in children with sepsis,so as to provide a better basis for the evaluation,prevention and treatment of ALI.MethodsSixty children aged 67.25±27.19 months old including 38 male cases who met the diagnosis standard of pediatric sepsis that was from expert consensus on diagnosis and treatment of septic shock in children published in 2015 were included in a clinical prospective observational study.Serum was collected from all the patients and BALF was collected from some of them.All of patients were divided into ALI group vs.Non-ALI group in term of ALI occurred or not at 48h after admission.The serum levels of endocan,IL-6 and IL-8 on admission were measured between the two groups by enzyme linked immunosorbent assay.And the BALF levels of endocan were measured in part of those.Simultaneously,the clinical data of all children were collected,including blood routine,CRP,PCT,blood gas analysis results,lung injury prediction score(LIPS)and pediatric critical illness score(PCIS).SPSS 24.0 software was used to compare the predictive ability of endocan,IL-6,IL-8,CRP,PCT,LIPS,PCIS,WBC,so as to obtain sensitive and specific markers for predicting ALI in children with sepsis.ResultsThere were 60 children with sepsis,18 in ALI group and 42 in non ALI group.There was statistical difference between the two groups in gender(P<0.05),and there was no statistical difference in age.Among them,there were 15 children with BALF,5 children with ALI and 10 children without ALI.(1)CRP,PCT,WBC,NEU,LIPS,IL-6,IL-8,in ALI group were higher than those in non ALI group.PCIS,Pa02/Fi02 ratio and the serum levels of endocan were lower than those in non ALI group.But there was no significant difference in CRP,PCT,WBC and NEU.The endocan concentrations(ng/ml)in BALF for children with ALI were 0.36,0.34,1.45,0.87and0.58,with an average of 0.72.The average concentration of endocan(ng/ml)in BALF of children without ALI was 2.65.From the numerical point of view,endocan concentrations in BALF for children with ALI was lower than that of children without ALI.However,owing to the few cases,it is not significant to predict in this experiment.In the next step,large samples should be collected and measured in future experiments to further explain the value that endocan concentrations in BALF will be predictive of ALI in children with sepsis.(2)According to Area under curves(AUC),the endocan levels in serum and other indicators have strong predictive value for ALI in children with sepsis,especially the serum levels of endocan.However,there is no significant difference in WBC,CRP and PCT.(3)Endocan was used to predict the occurrence of ALI at 48h in children with sepsis.The optimal cutoff point of serum endocan was 2.795ng/ml,and the sensitivity and specificity were 0.833(95%CI0.739-0.927)and 0.619(95%CI0.496-0.742),respectively.The positive predictive value and negative predictive value were 0.484 and 0.897,while the positive likelihood ratio and negative likelihood ratio were 2.186 and 0.269.For the serum level of endocan,although the sensitivity and specificity of the optimal cutoff point are high,the PPV is 0.484,which seriously limits the clinical relevance of early treatment according to endocan.When the serum endocan is 5.970ng/mls the sensitivity is the highest,but the specificity and PPV are lower.When the serum endocan was 0.490ng/ml,the specificity of prediction of ALI at 48h is the highest,meanwhile the sensitivity is low.The positive predictive value was 0.860,which was higher than the former.The value improves the prediction ability of ALI in clinical practice.(4)The incidence of ALI with serum endocan level less than 2.795ng/ml in children with sepsis is 8.033 times higher than that in children with serum endocan level more than 2.795ng/ml.(5)The serum levels of endocan are positively correlated with PCIS(r=0.394,P=0.002),Pa02/Fi02(r=0.508,P<0.001),but not with PCT,WBC,LIPS,IL-6,IL-8.Conclusion(1)The low level of endocan in serum can predict the occurrence of ALI in children with sepsis.(2)The incidence of ALI is higher in children with sepsis whose serum endocan level was lower than 2.795ng/ml.(3)Endocan in serum levels is superior to other indicators in predicting the occurrence of ALI in children with sepsis.