Clinical Study Of Variation Of The Fecal Elastase-1 Levels In Critically Ill Children

Objective: To determine the fecal elastase-1(FE-1) in critically ill children, to investigate the relationships between FE-1 and trypsin, sepsis and the severity of the disease.Method:Totally 402 critically ill children admitted in pediatric intens ive care unit(PICU)of Hunan Children’s Hospital from July 2013 to Marc h 2014 were studied. Keeping the forming stool during the first 24 h admit ted to PICU. Subjects were divided to 3 groups according to fecal elastase-1(FE-1) concentration: >200 μg/g for normal pancreatic exocrine functi on(group A, n=300), 100-200 μg/g for mild to moderate exocrine pancrea tic insufficiency(group B, n=52), <100 μg/g for severe pancreatic exocrin e insufficiency(group C, n=50), analyzed the relationships between FE-1 and pancreatic enzymes, sepsis and its severity, and shock, the number of organ dysfunction, PCIS score, SOFA score, APACHE II score. Chi-squared test was used for data statistical. The median and four percentile interval were used for the measurement data of non-normal distribution or non-neat variance, the rank sum test of each two of multiple samples compare with each other was used for non parametric test, only when it was statistically significant, and the spearman method of correlation analysis was used for correlation analysis.Results:(1) The proportions of pancreas injury-related manifestations among the three groups were significantly different, including diarrhea, bloating, vomiting, abdominal tenderness and decreased bowel sounds(Group A< Group B <Group C, P<0.05). Only 6 cases of 53 cases of pancreatic B-ultra examination were abnormal, including 4 cases in Group B(4/28, 14.29%) and 2 cases in Group C(2/25, 8.00%).(2) Among the three groups, lipase rise and the C-peptide abnormity had statistically differences(P<0.05), while serum amylase elevated 1 times, 2 times and 3 times, urinary amylase rise and the insulin abnormity had no statistically differences(P>0.05).(3) Children with sepsis were divided into three groups according to the severity of sepsis: mild sepsis group(n=86, 43.37%),severe sepsis group(n=16, 23.89%),and shock septic group(n=12, 7.29%). FE-1 levels between different degrees of sepsis and non-sepsis group were significant differences(P<0.01). The general trend in FE-1 concentrations decreased along with the severity of sepsis.(4) Shock, organ dysfunction number(MODS ≥ 3), PCIS score, SOFA score, APS scores were associated with FE-1,the three groups were statistically different(P<0.05). Along with FE-1 level decreased, the number of organ dysfunction, SOFA score, APS score increased and PCIS score decreased(rs1=-0.194, P=0.000; rs2=-0.348, P=0.000; rs3=-0.176, P=0.000; rs4=0.185, P=0.000).Conclusions : Along with FE-1 concentration decreased, the corresponding pancreatic exocrine dysfunction clinical symptoms and signs appear, but no significant imageology changes. There were correlations between FE-1 and sepsis and its severity. FE-1 has a certain significance for the diagnosis of pancreatic injury in critically ill children and predicting the severity of the disease.