| Objective Biomarkers have important clinical value in the diagnosis,treatment and prognosis of sepsis and disseminated intravascular coagulation(DIC).This study aimed to establish an effective biomarker combination to explore its role and significance in sepsis related disseminated intravascular coagulation(SEDIC).Methods A single-center,prospective clinical observational study was conducted in September 2017 to September 2018 at the Children's Medical Center of the Affiliated Hospital of Qingdao University.Children with sepsis who met the inclusion criteria were studied at the same time.Non-infected children in pediatric surgery in the affiliated hospital were healthy controls.Record the general clinical data of the child,including age,gender,etc.,and take peripheral blood biomarkers,observe and record biomarkers such as blood routine,hemagglutination routine,biochemistry,etc.,and use sequential organ failure scores.(Seqeuntial Organ Failure Assessment,SOFA)and Acute Physiology and Chronic Health Status Scoring System(APACHE II score)to assess organ dysfunction and "China Disseminated Intravascular Coagulation Integration Systematization(CDSS)" to assess coagulation function and to include studies The children were followed up for 28 days,and the 28-day prognosis was recorded.The children who gave up treatment due to social factors were included in the death group.Data analysis and statistical processing were performed using SPSS 22.0 statistical software.Results ? 79 patients were enrolled during the study period,including 32 in the sepsis group,26 in the severe sepsis group,and 21 in the septic shock group.?Among the children included in the study,53 were non-DIC children(28/32 in the sepsis group,16/26 in the severe sepsis group,4/21 in the septic shock group),and 26 in the DIC group(septic group 4/32,severe sepsis group 10/26,septic shock group 17/21);?In the sepsis group,severe sepsis group,and septic shock group,gender(X2=1.158,P=0.561),age(H-=1.951,P=0.149),and hospital temperature(F=3.950,P=0.076)There was no significant difference in the infection site(X2=6.229,P=0.196)(P>0.05),but in the SOFA score(F=4.227,P=0.017)and APACHE? score(F=4.942,P=0.009).Comparing,the scores of the two were positively correlated with the severity of sepsis,and the differences were statistically significant(P<0.05);?There were no significant differences in gender(X2=0.156,P=0.693),age(H=1.462,P=0.148),hospital temperature(t=3.850,P=0.056),and infection sites between the non-DIC group and the DIC group.(P>0.05),and in the SOFA score(t=6.589,P<0.001),APACHE ? score(t=6.321,P<0.001),CDSS score(t=9.492,P<0.001),the three were in non-DIC and The differences between the DIC groups were statistically significant(P<0.05),and positively correlated with the severity of coagulation function;? Sepsis,severe sepsis,septic shock group,as a biomarker of inflammation,the area under the ROC curve of PCT for early diagnosis of sepsis was 0.902,higher than the area under the ROC curve of CRP,WBC,ALB,FYS.(The areas under their ROC curves are 0.853,0.507,0.723,0.682,respectively),and when PCT=6.5 ng/ml,the sensitivity is 93.2%,the specificity is 79.4%;as a coagulation biomarker,ACT-III is early The area under the ROC curve for the diagnosis of sepsis was 0.826,which was higher than the area under the ROC curve of Fib,D-Dimer,PLT and PT(the areas under their ROC curves were 0.765,0.634,0.683,0.815,respectively),and AT-III At 60.3%,the sensitivity is 76.3%and the specificity is 80.9%.?In the DIC group,as an inflammatory biomarker,the area under the ROC curve of PCT for early diagnosis of DIC was 0.815,which was higher than the area under the ROC curve of CRP,WBC,ALB,and FYS(the areas under their ROC curves were 0.734,0.537,and 0.792,0.503,respectively)and with PCT=13.1ng/ml,the sensitivity is 83.4%,the specificity is 78.4%;as a coagulation biomarker,the area under the ROC curve of ACT-? for early diagnosis of DIC is 0.853,higher than Fib The area under the ROC curve of D-Dimer,PLT and PT(the areas under their ROC curves are 0.795,0.847,0.832,0.807,respectively)and when AT-?=42.6%,the sensitivity is 89.5%,and the specificity is 73.6.%;? In this study,the best combination of biomarkers was PCT and AT-?.According to the cut-off value,the study samples were divided into three groups:recessive SEDIC=46 cases,suspected SEDIC=23 cases,dominant SEDIC=In 10 cases,SOFA score(F=3.784,P<0.001)and APACHE ? score(F=5.358,P<0.001),the scores of the two were positively correlated with the severity of SEDIC,and the differences were statistically significant(P<0.05)?Conclusion 1.PCT and AT-? as biomarker combinations have clinical significance in early diagnosis of children with sepsis complicated with coagulopathy;2.SOFA score and APACHE ? score in early assessment of children with sepsis combined with coagulation severity significance. |
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