Prognostic Value Of Serum Lactate Dehydrogenase Levels In Children With Sepsis

Objective:To investigate the predictive value of serum lactate dehydrogenase levels within 24 hours on the severity and prognosis of children with sepsis.Methods:A total of 95 children with sepsis who were hospitalized in the pediatric intensive care unit of our hospital from February,2019 to March,2021 were collected as research subjects.95 patients were divided into sepsis group（n=49）,severe sepsis group（n=31）and septic shock group（n=15）according to the severity of disease.According to whether MODS occurred or not,95 patients were divided into sepsis without MODS（n=65）and sepsis with MODS（n=30）.And they were divided into survivors group（n=83）and non-survivors group（n=12）according to the 28-day prognosis.Spearman rank correlation analysis was used to analyze the correlation between LDH levels to other clinical and laboratory parameter.Logistic analysis was used to determine the independent risk factors of sepsis with MODS and prognosis in children.ROC curve was drawing to evaluate the predictive value of independent risk factors for the severity,MODS and prognosis of sepsis.Result:1.The serum LDH levels of children with sepsis,severe sepsis and septic shock were[820.00（720.00,970.00）、1025.00（962.00,1320.00）、1310.00（1032.00,1848.75）U/L],the differences among them was statistically significant（H=27.918,P<0.001）.The LDH levels of sepsis children without MODS was[932.00（744.00,1025.00）U/L],which was significantly lower than sepsis children with MODS[1290.00（1029.25,1848.75）U/L],and the differences among them was statistically significant（Z=-5.024,P<0.05）.Serum LDH was significantly increased in non-survivors[1420.00（1180.00,2145.00）U/L]compared to survivors[948（772.5,1130）U/L]（Z=-3.649,P<0.001）.2.The results of Spearman rank correlation showd that LDH levels were positively correlated with hospital stays（r_s=0.281,P<0.001）,CRP（r_s=0.343,P<0.05）,procalcitonin（r_s=0.628,P<0.001）,CK-MB（r_s=0.312,P<0.05）,creatinine（r_s=0.282,P<0.05）,AST（r_s=0.308,P<0.05）,ALT（r_s=0.352,P<0.05）.3.Levels of LDH（OR=1.002,95%CI 1.000～1.005,P<0.05）,procalciton（OR=4.219,95%CI 2.039～8.728,P<0.001）were independent risk factors for MODS of children with sepsis;serum LDH（OR=1.001,95%CI 0.999～1.002,P<0.05）,procalcitonin（OR=1.898,95%CI 1.171～3.076,P<0.05）were also independent risk factors for death of children with sepsis.4.The receiver operating characteristic（ROC）curves showed that the area under the LDH curve for prediction for severe sepsis was 0.825,for septic shock was 0.870,for MODS was 0.832,for mortality was 0.799.The AUC of procalciton for prediction for severe sepsis was 0.828,for septic shock was0.870,for MODS was 0.803,for 28-day mortality was 0.814.Conclusions:Serum LDH levels is closely related to the severity and 28-day prognosis of children with sepsis,and is an independent risk factor for early prediction of MODS and 28-day mortality in children with sepsis.It has good predictive value for predicting the disease severity,occurrence of MODS and prognosis in children with sepsis.It can be used as a valuable biomarker for evaluating the severity and prognosis of sepsis in children.