Study On The Clinical Significance Of Critical Ill Children With High Serum Procalcitonin

Objective： To analyze the clinical data of critically ill children with highprocalcitonin(PCT) level, to know the clinical, biochemical and prognosis characteristicsof critical ill patients with high PCT level, and make a preliminary discussion on theclinical significance of patients with high PCT level and the influencing factors associatedwith PCT>10ng/ml in critical ill patients.Methods：392critically ill patients with high PCT level admitted to the PICU of HunanChildren’s Hospital from April2012to June2013were enrolled in this study. Inaccordance with the contemplated the clinical registration form to collect information totake the prospective observational and analysis. PCT, Blood Routine, C-ReactiveProtein(CRP), examine of pathogen were measured. The data of clinical manifestations,medical condition development, sputum culture, organ function and prognosis weresummarized and statistically analyzed.Results1. Serum PCT had a positive correlation with CRP and the percentage of Neutrophi(NEU%)(P<0.01); Sputum bacterial culture positive and negative groups, PCT, CRP, WBCand NEUT%levels were increased in varying degrees when sputum culture was positive,of which PCT levels increased obviously. The differences of PCT was statisticallysignificant(P<0.01), while the differences of CRP,WBC,NEUT%were not statisticallysignificant(P>0.05).2. PCT level was higher in247sepsis group than that in145non-sepsis group and thedifferences were statistically significant (P<0.01); PCT level was statistically significantamong non-sepsis group, mild sepsis group, severe sepsis and group septic shockgroups.Unless sepsis group and mild sepsis showed no statistical significance(P>0.05), theremaining two groups were statistically significant differences (P<0.01). The area under the ROC curve of PCT diagnosis of sepsis, severe sepsis and septic shock were0.592(95%CI:0.505,0.620),0.702(95%CI:0.634,0.771),0.839(95%CI:0.767,0.910), indicating thatthe diagnostic performance of PCT for sepsis, severe sepsis, septic shock were graduallyimproved.3. For different levels of elevated PCT levels A, B, C groups, biochemical markers oforgan function: ALT, AST, BUN, Cr, LDH, CK-MB were gradually increased. PCT levelwas statistically significant (P<0.01).234children had no organ failure(59.69%),92children had a single organ failure(23.47%)and66children had mutiple organfailure(16.84%).The highest rate of non-organ failure occurred in A group (68.05%), whilethe highest rate of multiple organ failure occurred in group C (25.86%).The difference ofthe three groups was significance (P<0.01).It showed that higher serum PCT was measured,the more likely organ function failure would happen.4.There were63death patients in392PICU patients. The PCT and WBC level in deathpatients were higher than that in survival patients. The differences were statisticallysignificance (P<0.01). The area under the ROC curve for PCT assessing prognosis was0.76（95%CI:0.693,0.827）. For different levels of elevated PCT levels A, B, C groups,the number of deaths children were gradually increased, while the number of survivalgroup were gradually decreased. The difference was statistically significant (P<0.01).5. Hepatic dysfunction, septic shock and PCIS<80points affect were the risk factorsassociated with PCT>10ng/ml in critical ill patients.Conclusions：1.Serum PCT level is closely related with the infection, sepsis and severity of illness.Especially when bacterial infections, PCT levels increased obviously.2.With the elevated serum PCT level, especially when PCT>10ng/ml, the mortalitygradually increased, indicating a poor prognosis.