| Objective:To analyze the changes of procalcitonin(PCT)and red blood cell distribution(RDW)in premature infants with sepsis,and to explore its value in evaluating the severity and prognosis of sepsis in premature infants.Methods:Medical records of 96 premature infants was confirmed sepsis admitted to the neonatal intensive care unit(NICU)of hospital from December 2014 to December 2019 were analyzed retrospectively,According to the severity of the disease and neonatal shock score,42 cases were divided into severe sepsis group(severe clinical condition,combined with shock,shock score > 6 points)and 54 cases were divided into mild sespis group(mild clinical condition,not combined with shock or shock score ?6points).According to whether the sepsis of premature infants died after 3 days of treatment,they were divided into 10 patients in the death group and 86 patients in the survival group(survived during hospitalization).PCT and RDW were measured before onset,before treatment,on the first day after treatment,and on the third day after treatment.The dynamic changes of the two indexes in premature infants with sepsis of different severity were compared.The Mann-whitney U Test,Wilcoxon Rank Sum Test,Friedman Test and ROC curve were used to analyze the data.Results:Before treatment,on the first day after treatment,and on the third day after treatment,the severe sepsis group had a higher level of PCT than the mild sepsis group[3.7(0.4?37.3)and 1.4(0.2?5.0)ng/ml,43.1(18.7?83.0)and 17.1(4.1?34.6)ng/ml,26.1(3.8?67.3)and 4.8(0.26?32.9)ng/ml,respectively,and Z values were-2.017,-3.350and-2.932,respectively,P< 0.05].Between two groups,PCT of the first day after treament were higher than that of the third day after treatment,and the third day after treatment was higher than that before treatment(P<0.05).On the first day and the third day after treatment,RDW in the severe group was higher than that in the mild group[16.5%(16.2%?18.6%)and 16.3%(15.5%?17.3%),16.1%(15.5%?19.4%)and15.7%(15.1%?16.5%),Z values are-1.992 and-2.165,P < 0.05],however,there was no statistically significant difference between the two groups before treatment[15.9 %(15.4%?17.2%)and 16.0%(15.1%?17.4%),Z=-0.410,P < 0.05].Between two groups,the RDW on the first day after treatment was higher than that before treatment and on the third day after treatment;in the mild group,the RDW on the third day after treatment was lower than that before treatment;but in the severe group,the RDW on the first day after treatment was higher than that before treatment(P< 0.05).(2)On the first and third day after treatment,procalcitonin and RDW in the death group were higher than those in the survival group [procalcitonin: 162.0(62.9-187.2)and 19.9(4.3-46.1)ng/ml,122.6(65.0-180.8)and 6.2(0.5-32.9)ng/ml,respectively,with Z values of-4.114 and-4.594,respectively;RDW: They were 18.4%(16.9%?21.2%)and 16.3%(15.7%?17.2%),21.8%(20.6%?22.2%)and 15.8%(15.2%?16.5%),Z values were-3.307 and-4.831,respectively;P < 0.05],but there was no statistically significant difference between the two groups before treatment [12.1(0.3?82.3)and1.6(0.3?14.3)ng/ml,16.0%(15.8%?16.8%)and 15.9%(15.3%?17.4%),Z values were-1.308 and-0.726,respectively.P >0.05].Procalcitonin on the frist day after treatment was higher than that before treatment and on the third day after treatment,and the third day after treatment was higher than that before treatment(P < 0.05).In thedeath group RDW on the first and third day after treatment was higher than that before treatment,and RDW on the third after treatment was higher than that on the first day.In the survival group,RDW on the first day after treatment was higher than that before treatment,but on the third day after treatment was lower than that before treatment and on the third day after treatment(both P values were < 0.05).(3)The cut-off values of procalcitonin for predicting severe sepsis in premature infants before and after treatment were 3.475,29.765 and 3.460 ng/ml,respectively,and the sensitivity and specificity were 54.8% and 75.9%,69.0% and 72.2%,83.3% and 46.3%,respectively.The cut-off values of procalcitonin for predicting the death of premature septicaemic infants on the 1st and 3rd day after treatment were 40.595 and 64.855 ng/ml,respectively,with specificity of 73.3% and 87.2%,respectively,and sensitivity of100%.The predictive thresholds of RDW on the first and third days after treatment were 15.650% and 18.300%,respectively,and the sensitivity and specificity were95.2% and 29.6%,33.3% and 92.6%,respectively.The predictive thresholds for mortality were 16.650% and 18.450%,and the sensitivity and specificity were 100.0%and 68.6%,100.0% and 91.9%,respectively.Conclusions:Levels of PCT and RDW and their changes can help with the early diagnosis of severe sepsis in premature infants,and has some value for the assessment of severity and prognosis of sepsis in premature infants. |
PDF Full Text Request