| Objective:In this study,the levels of serum Pentraxin-3(PTX-3),Copeptin(CPP)and Clq/tumor necrosis factor related protein3(CTRP3)were measured by Enzyme-linked immunosorbent assay(ELISA)in patients with different severity of infections.The traditional factors including procalcitonin(PCT),C-reactive protein(CRP),white blood cell(WBC),neutrophil(NEUT),neutrophil percentage(NEUT%)and lymphocytes(LYM)in pathogenic infectious diseases were selected as controls to compare with PTX-3,CPP and CTRP3 in the clinical diagnostic value in children with sepsis.Methods:In this study,from October 2021 to December 2022,children admitted and diagnosed with sepsis and pneumonia in the same period were selected as subjects,and healthy children matched with age and sex were selected as the control group.They were divided into three groups:sepsis group,pneumonia group and healthy control group.There were 60 children in sepsis group(38 males and 22 females,aged0-13 years),30 children in pneumonia group(17 males and 13 females,aged 0-14years)and 30 healthy controls(14 males and 16 females,aged 0-14 years).There was no significant difference in age and sex among the three groups(P>0.05).Venous blood samples were collected in sepsis group and pneumonia group within 24 hours after admission,while venous blood samples were taken in healthy group on the day of physical examination,and serum was obtained by centrifugation.The levels of PTX-3,CPP and CTRP3 were measured by ELISA method,and the levels of CTRP3,PTX-3,CPP,PCT,CRP,WBC,NEUT,NEUT%and LYM were recorded.All the data in this study are processed and analyzed by SPSS26.0 and Stata16.0 statistical software.The measurement data are expressed by(x±s),comparison between groups:independent sample t test was used for normal distribution,and Mann-Whitney U test was used for comparison of non-normal distribution.The comparison between groups is compared by single factor analysis of variance,pairwise comparison is expressed by LSD-t test,and the correlation is analyzed by Spearman correlation coefficient model.The diagnostic efficacy analysis uses the Receiver operating characteristic curve(ROC),Area Under Curve(AUC),95%confidence interval,sensitivity,specificity and the best cut-off value.The joint prediction implements logistic binary regression fitting and returns the prediction probability logit(p),which is used as an independent test variable.Results:1.Serum CTRP3,PTX-3 and CPP levels were different among the three groups:sepsis group:CTRP3(ng/m L):47.44(40.22-60.06);PTX-3(pg/m L):79.41(43.71-97.99);CPP(pg/m L):164.79(152.97-180.38);Pneumonia group:CTRP3(ng/m L):60.82(51.41-74.19);PTX-3(pg/m L):39.61(24.08-43.66);CPP(pg/m L):139.65(76.86-181.07);Health group:CTRP3(ng/m L):69.61(62.78-77.40);PTX-3(pg/m L):37.44(20.63-49.39);CPP(pg/m L):98.95(83.77-95.16);The PTX-3 and CPP levels in sepsis group were significantly higher than those in pneumonia group and healthy control group,while the CTRP3 levels were significantly lower than those in pneumonia group and healthy control group,with statistical difference(P<0.05).The levels of PTX-3 and CPP in pneumonia group were higher than those in healthy control group,but the levels of CTRP3 were lower than those in healthy control group,with statistical significance(P<0.05).2.ROC curve of CTRP3,PTX-3,CPP,PCT,CRP,WBC,NEUT,NEUT%and LYM was plotted.The AUC of CTRP3 was 0.836(95%confidence interval:0.7588-0.897),the optimal cut-off value of CTRP3 is 61.48 ng/m L,the sensitivity is90.00%,and the specificity is 73.33%.When PTX-3 had an area under ROC curve of 0.780(95%confidence interval:0.696-0.851)and an optimal cut-off value of43.16 pg/m L,its sensitivity and specificity were 78.33%and 71.67%respectively.When the AUC of CPP in the diagnosis of sepsis was 730(95%confidence interval:(0.642 to 0.807),and the optimal cut-off value was 116.52 pg/m L,the sensitivity was98.33%,and the specificity was 65.00%.When the AUC of PCT for diagnosing sepsis was 0.760(95%confidence interval:0.658-0.844),and the optimal cut-off value was 0.33 ng/m L,the sensitivity and specificity were 98.33%and 53.33%respectively.When the AUC of CRP in the diagnosis of sepsis was 0.686(95%confidence interval:0.580-0.780),and the optimal cut-off value was 40.46 mg/L,the sensitivity was 60.00%,and the specificity was 86.67%.When the AUC of WBC in the diagnosis of sepsis was 0.749(95%confidence interval:0.677-0.835),and the optimal cut-off value was 9.93*10~9/L,the sensitivity and specificity were 80.00%and60.00%respectively.When the AUC of NEUT in the diagnosis of sepsis was 0.791(95%confidence interval:0.693-0.870),the optimal cut-off value was 6.08*10~9/L,the sensitivity was 88.33%,and the specificity was 60.00%.When the AUC of NEUT%in the diagnosis of sepsis was 0.744(95%confidence interval:0.642-0.831),and the optimal cut-off value was 61.2%,the sensitivity and specificity were 86.67%and53.33%.When the AUC of LYM for diagnosing sepsis was 0.585(95%confidence interval:0.476-0.688),and the optimal cut-off value was 2.31*10~9/L,the sensitivity and specificity of LYM were 63.33%and 63.33%.3.The ROC curve of multi-index combined diagnosis was plotted,and the area under the curve was as follows:CTRP3+PTX-3 was 0.846(95%confidence interval:0.769-0.906),the sensitivity was 96.67%,and the specificity was 58.33%.CTRP3+CPP was 0.828(95%confidence interval:0.748-0.891),sensitivity was98.33%,specificity was 65.00%.PTX-3+CPP was 0.842(95%confidence interval:0.764-0.902),sensitivity was 93.33%,specificity was 60.00%.CTRP3+PTX-3+CPP is 0.855(95%confidence interval:0.779-0.913),the sensitivity is 96.67%,and the specificity is 58.33%.The CTRP3+PTX-3+CPP+PCT was 0.808(95%confidence interval:0.711-0.883),the sensitivity was 78.33%,and the specificity was 70.00%.CTRP3+PTX-3+CPP+NEUT%was 0.871(95%confidence interval:0.783-0.932),the sensitivity was 71.67%,and the specificity was 93.33%.The CTRP3+PTX-3+CPP+NEUT was 0.913(95%confidence interval:0.834-0.962),the sensitivity was 83.33%,and the specificity was 83.33%.The value of CTRP3+PTX-3+CPP+WBC was 0.884(95%confidence interval:0.800-0.942),the sensitivity was 68.33%,and the specificity was 93.33%.The value of CTRP3+PTX-3+CPP+NEUT%+PCT was 0.912(95%confidence interval:0.834-0.962),the sensitivity was 80.00%,and the specificity was 86.67%.The diagnostic efficacy of CTRP3,PTX-3,CPP and NEUT was the highest in combination with 83.33%sensitivity and 83.33%specificity when the above indexes were combined or combined with multiple indexes.Conclusions:1.CTRP3,PTX-3 and CPP can be used as reference indexes to distinguish children with sepsis from healthy children.The levels of PTX-3 and CPP are increased in children with sepsis,while CTRP3 is decreased.CPP can be used as a reference index to identify children with sepsis,pneumonia and healthy children.The serum level of CTRP3 can be used as a reference index to indicate the severity of sepsis.With the increase of sepsis severity,the serum CTRP3 level decreases.2.ROC curve analysis showed that CTRP3 had the highest diagnostic performance,WBC followed by CRP.The diagnostic performance of PCT was higher than that of CPP and lower than that of PTX-3.3.Under the condition of combination of two indicators or multiple indicators,the diagnostic efficiency was improved in different degrees.The combination of CTRP3,PTX-3,CPP and NEUT has the highest diagnostic efficacy.When the serum concentration of CTRP3 is lower than 61.48 ng/m L,PTX-3 is greater than 43.16pg/m L,CPP is greater than 116.52 pg/m L and NEUT is greater than 6.08*10~9/L,the AUC of sepsis was 0.913,the sensitivity was 83.33%,and the specificity was83.33%. |
PDF Full Text Request