Change Of Complement And Its Relationship With Coagulation In The Children With Sepsis

Objective：To observe the change of complement in peripheral blood in children withsepsis， discuss the influence of Complement3（C3） depletion on pathogeneticcondition and prognosis and C3’s relationship with coagulation function.Methods:1to12years children with sepsis admitted in pediatric intensive careunit(PICU) of Hunan Children’s Hospital from May,2012to Jan,2013were reviewed andanalyzed. Children with the following conditions were excluded:congenitalimmunodeficiency, autoimmune diseases, immunodeficiency diseases, hematologicaldiseases, cancer, primary liver disease, chronic viral infections (HIV, hepatitis B or C),hypersensitivity disorders, diabetes, immune complex-induced chronic glomerulonephritis(MPGN), acute glomerulonephritis, streptococcal infection (AGN), lupus nephritis,malnutrition, a history of the use of immunosuppressants, the recent use of heparin, pre-hospital use of hormones and/or infusion blood products, blood purification beforemeasurement, radiation-induced neutropenia, chemotherapy-induced malignant lymphomaand those younger than1year old. All the children were given the PCIS scroes within24hafter admission. C3、 C4、 coagulation parameters and other biochemical indicatorswere measured and detected.Results1.IgG、IgM in C3depletion group were significantly lower than the control group andCD3+T、CD4+T、CD8+T percent were higher than the control group(P <0.05).2. PCT in C3depletion group were significantly higher than the control group(P <0.05).3. PCIS in C3depletion group were significantly lower than the control group(P <0.05).According to the different level of PCIS score,all cases were divied into more than90points,71to90points and70points or less three groups. The results show: With the PCISscore lower, C3, C4gradually reduced, the difference was statistically significant (P<0.05).The proportion PCIS equal to70points or less in C3depletion group weresignificantly higher than the control group(P <0.01). 4. Serum C3, C4levels in severe sepsis group was signifcantly lower than the sepsis group(P <0.01), the proportion of children with severe sepsis in C3depletion group weresignificantly higher than the control group (P <0.01).5. All the cases were divided into three group according to the number of organ failure onadmission: no organ failure group, two organ failure group, multiple organ failure or shockgroup.We found that the more the number of multiple organ failure, the lower of the serumC3levels were (P <0.01).The proportion of multiple organ failure or shock in C3depletiongroup were significantly higher than the control group (P <0.01).6. Serum C3, C4levels in non survival group was signifcantly lower than the survivalgroup (P <0.01). The mortality rate in C3depletion group were significantly higher thanthe control group (P <0.01).7.18of160cases occurred clinical coagulation dysfunction, of which C3depletionincidence reached66.67%;8of18cases was diagnosed with DIC, of which C3depletionincidence reached75.00%; The proportion of coagulation dysfunction in C3depletiongroup were significantly higher than the control group (P <0.01).PT and APTT in C3depletion group were significantly higher than the control group (P<0.01); D-dimer positive rate in C3depletion group were significantly higher than thecontrol group (P <0.05); complement C3and PT, FIB, Plt were related with each other (P<0.01).Conclusions1.Children with sepsis presented complement C3depletion.2. Septic children with C3depletion appeared coagulation dysfunction.C3depletion inchildren with sepsis was associated with D-dimer.3. C3depletion in septic children prompted a serious condition, the prognosis is poor.