摘要
目的探讨体温、小儿危重病例评分(PCIS)、白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)及肾上腺髓质素前体(pro-ADM)对预测PICU医院感染的价值。方法选取2016年6月至2017年3月收入复旦大学附属儿科医院PICU的急危重症患儿,依据医院感染的诊断标准分为院感组和非院感组;连续记录4个时点[T1为入PICU后4 h内,T2~T4分别为T1后(48±1)h、(120±1)h和(192±1)h]的体温、PCIS、WBC、CRP、PCT及pro-ADM,分析发生医院感染时,距离其发生前最近时点(Th)的各指标对医院感染的预测价值。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)、敏感度和特异度,并采用多因素Logistic回归分析研究医院感染的危险因素。结果共纳入85例患儿,院感组27例,非院感组58例。入PICU时,两组患儿在年龄、体重、体温、WBC、PCT、pro-ADM、原发疾病、侵袭性操作方面的差异均无统计学意义(P均>0.05);在性别、PCIS、CRP、气管插管率和中心静脉置管率方面的差异均有统计学意义(P均<0.05)。Th时,院感组与非院感组间体温、PCIS、CRP、PCT及pro-ADM的差异均有统计学意义(P均<0.05),AUC分别为0.787、0.755、0.709、0.704和0.809,预测医院感染的最佳界值依次分别为38.0℃、87分、14.5 mg/L、0.28 ng/mL和0.67 nmol/L;WBC在两组之间差异无统计学意义(P>0.05)。体温PCIS和pro-ADM的敏感度较高,pro-ADM和PCIS特异度较高。PCIS可能是发生医院感染的独立危险因素(OR=0.978,95%CI 95.9~99.9,P<0.05)。结论pro-ADM对医院感染的预测具备较高的敏感度和特异度,PCIS是发生医院感染的独立危险因素。
Objective To explore the value of body temperature,pediatric clinical illness score(PCIS),white blood cell count(WBC),plasma C-reactive protein(CRP),procalcitonin(PCT)and pro-adrenomedullin(pro-ADM)in predicting nosocomial infection in PICU.Methods From June 2016 to March 2017,the critically ill children in PICU of Children′s Hospital of Fudan University were selected and divided into nosocomial infection group and non nosocomial infection group according to the diagnostic criteria of nosocomial infection.The body temperature,PCIS,WBC,CRP,PCT and pro-ADM were recorded at 4 hours(T1),(48±1)hours(T2),(120±1)hours(T3)and(192±1)hours(T4)after admission,and their predictive value of each index,which was the closest time point(Th)to nosocomial infection was analyzed.Receiver-operating characteristic(ROC)curves were performed to calculate the areas under the curves(AUC),sensitivity and specificity,and multivariate Logistic regression analysis was used to study the risk factors of nosocomial infection.Results A total of 85 cases were included,including 27 cases in nosocomial infection group and 58 cases in non nosocomial infection group.There was no significant difference in age,weight,body temperature,WBC,PCT,pro-ADM,primary disease and invasive operation between two groups(all P>0.05).There were significant differences in gender,PCIS,CRP,intubation rate and central venous catheterization rate(P<0.05),when patients were admitted to PICU.At Th,the differences of body temperature,PCIS,CRP,PCT and pro-ADM between two groups were statistically significant(P<0.05),as well as the AUC were 0.787,0.755,0.709,0.704 and 0.809,respectively,as well as the best cut-off values for predicting nosocomial infection were 38.0℃,87 points,14.5 mg/L,0.28 ng/mL and 0.67 nmol/L,respectively.There was no significant difference regarding WBC between two groups(P>0.05).PCIS may be an independent risk factor for nosocomial infection(OR=0.978,95%CI 95.9-99.9,P<0.05).Conclusion Pro-ADM has high sensitivity and specificity in predicting nosoc
作者
张晓磊
程晔
刘静
闫钢风
陈伟明
陆国平
Zhang Xiaolei;Cheng Ye;Liu Jing;Yan Gangfeng;Chen Weiming;Lu Guoping(Department of Pediatric Emergency and Critical Care Center,Children′s Hospital of Fudan University,Shanghai 201102,China)
出处
《中国小儿急救医学》
CAS
2021年第10期874-878,共5页
Chinese Pediatric Emergency Medicine
关键词
体温
小儿危重病例评分
白细胞计数
C-反应蛋白
降钙素原
肾上腺髓质素前体
儿童重症监护病房
医院感染
Body temperature
Pediatric critical illness score
White blood cell count
C-reactive protein
Procalcitonin
Pro-adrenomedullin
Pediatric intensive care unit
Nosocomial infection
