Analysis Of High Risk Factors For Mortality In Children With Sepsis

BackgroundSepsis is a life-threatening organ dysfunction caused by dysregulation of the host response due to infection,which can further develop into septic shock.Today,in the world,sepsis is still an important cause of death in children.Therefore,early assessment of the prognosis of sepsis is extremely important.In recent years,a large number of studies have found that platelets play an important role in sepsis.Secondly,Pediatric Critical Illness Score in China are often used to assess the severity and prognosis of sepsis patients.Therefore,summarizing the critical values and range of changes in Pediatric Critical Illness Score and platelet count can help early assessment of the prognosis of sepsis.And it also has a guiding significance for the treatment of sepsis patients.In addition,sepsis 3.0 incorporates SOFA into the diagnostic criteria.However,there is currently no recognized age-adapted SOFA for children.This study uses the pSOFA score developed by Matics et al.to explore its predictive value for the risk of death in children with sepsis.Objective1.To study the correlation between the changes of platelet count,critical child case score,pSOFA score and survival status at discharge in sepsis;2.To study platelet count and PCIS score in evaluating the prognosis of sepsis and the range of early warning values for poor prognosis;3.To study the pSOFA score for evaluating the prognostic value of children with sepsis.Methods1.Collection of patientsThrough retrospective study of clinical data,we collected the patients with sepsis from January 01,2014 to June 30,2019 in Zhujiang Hospital of Southern Medical University as the research object,and collected their age,gender,total hospitalization time,and hospitalization time And the platelet count,Glasgow score,pSOFA score,critical child case score,total bilirubin level,creatinine,lactic acid,and hypersensitive C-reactive protein at admission and day 3.2.Group objectsAccording to the outcome when children were discharged,they were divided into the survival group and the death group.3.Date analysis methodsData collection was recorded using Excel 2019 tables,and statistical analysis was performed using IBM SPSS 20.0 software.The measurement data were expressed as mean±SD.Two independent sample t tests were used for comparison between groups;count data was described by frequency and percentage,and chi-square test was used for comparison between groups.Multi-factor logistic regression analysis was used to analyze the risk factors of children’s death;the receiver operating characteristics(ROC)curves were drawn for the high-risk factors PLT and PCIS scores for predicting the risk of death from sepsis.The non-parametric test was used to compare the area under the curve(AUC).P<0.05 was considered statistically significant.Results1.General informationA total of 180 patients were enrolled in the study,including 146 survivors,91 males and 55 females,with an average age of 14 months;34 deaths,20 males and 14 females,with an average age of 20 months.2.Analysis of high risk factors for death in patients with sepsis① The independent risk factors affecting the child’s survival status include PLT change value and PCIS change value;② The area under the ROC curve of platelet survival during admission is 0.612,which is statistically significant(P<0.05).The threshold is 237.5 × 10^9/L,and the sensitivity is 44.5%and the specificity is 76.5%.The area under the ROC curve of platelet survival on the third day of admission is 0.761,which is statistically significant(P<0.05)The threshold is 118.5× 10^ 9/L at the maximum of the Youden index,at this time the sensitivity is 70.5%and the specificity is 76.5%.③ The area under the ROC curve of the PCIS score at admission is 0.660,which is statistically significant(P<0.05).The threshold at the maximum of the Youden index is 83,the sensitivity is 68.5%,and the specificity is 61.8%.The area under the ROC curve of the PCIS score on the third day of admission is 0.89,which is statistically significant(P<0.05).The threshold is 83 points at the maximum of the Youden index.At this time,the sensitivity is 78.8%,and the specificity is 73.5%.④ At admission and on the third day of admission,the pSOFA score of the death group was higher than that of the survival group,and the pSOFA score of the death group showed an upward trend,while the survival group showed no significant changes.3.Research conclusions① The greater the change in the platelet value and the score of critically ill children,the increasing risk of mortality.② Platelets have a value to predict the risk of mortality,if PLT ≤237.5 × 10 ^ 9/L at the admission and PLT≤118.5 × 10 ^ 9/L on day 3,children have a higher risk of mortality.③The PCIS score has the value of predicting the risk of mortality of children.If the PCIS score is less than 83 points on admission and day 3,the children have a higher risk of mortality.④There is a correlation between the pSOFA score and the risk of mortality in children with sepsis,and it has predictive value for predicting the risk of mortality in children with sepsis.