Analysis Of Prognosis And Risk Factors In Children With Sepsis

Objective:To explore the relationship between chronic basic diseases,infection sites,white blood cell count,C-reactive protein,procalcitonin,albumin,sodium,lactic acid and cellular immune changes and the severity and prognosis of sepsis,to provide references for early clinical recognition,diagnosis and therapy,to improve the outcome.Method:The clinical data of children aged 0～14 years with sepsis and sepsis shock admitted to our hospital on June 30,2015 and June 30,2020 were retrospectively studied.Age,gender,chronic basic disease,infection site,C-reactive protein,procalcitonin,albumin,sodium,lactic acid,and cell subsets of sepsis children were obtained for univariate analysis.The OR value and 95%CI were obtained by multivariate analysis.Result:Of 202 cases analyzed cases,134 children(66.3%)were boys and 68(33.7%)were girls,and the ratio was 1.97:1,The majority of cases were 29 days-1year infants(160 cases,79.2%).The sex ratio in each age group was not statistically significant(P>0.05).The respiratory tract is the most common site of infection(93 cases,46.0%).Streptococcus pneumoniae(8 strains)was the most common strain of Gram-positive bacteria,while Escherichia coli(9 strains)was the main strain of Gram-negative bacteria.166 cases(82.2%)were improved or cured,and 36 cases(17.8%)were unhealed or died.Children with sepsis complicated with chronic underlying diseases did not recover or had higher mortality than those without chronic underlying diseases(X~2)=16.803,P=0.000),SOFA score of uncured or dead group was significantly higher than that improved or cured group(Z=-6.191,P=0.000).Prognosis in age(Z=-0.431,P=0.666),gender(X~2)=0.002,P=0.963),season(X~2)=1.102,P=0.777)and hospitalization days(Z=-1.879,P=0.060)were no statistical differences.SOFA score in children with long hospital stay(median level of 3 points)was significantly higher than that in children with short hospital stay(median level of 2 points)(Z=-2.349,P=0.019).In addition,albumin was significantly reduced in children with long hospital stay compared with those with short hospital stay(Z=-2.970,P=0.003).Univariate analysis revealed that SOFA score,procalcitonin and CD19+B cells were significantly higher in children with septic shock than in children with sepsis,while platelet count and albumin were significantly lower.Multiple logistic regression analysis showed that the higher SOFA score and procalcitonin,the lower CD8+T cells,and the higher the risk of septic shock.Conclusion:Sepsis was concentrated in 29 days～1year infants,boys were more than girls.Respiratory tract was the main site of infection,pathogen was mainly bacteria.About a third of cases were complicated with chronic underlying diseases.There were chronic underlying diseases and high SOFA scores in children with sepsis who did not recover or had higher mortality than those in improved or cured group.Albumin was significantly reduced in children with long hospital stay compared with short hospital stay.The higher the SOFA score and procalcitonin within 72 hours,the lower the CD8+T cell level,which was risk factor for the development of septic shock.