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Zhu YB, Liu TL, Dai Q, Liu SF, Xiong P, Huang H, Yuan Y, Zhang TN, Chen Y. Characteristics and Risk Factors for Pediatric Sepsis. Curr Med Sci 2024; 44:648-656. [PMID: 38748371 DOI: 10.1007/s11596-024-2870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/22/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Sepsis is considered a major cause of health loss in children and had high mortality and morbidity. Currently, there is no reliable model for predicting the prognosis of pediatric patients with sepsis. This study aimed to analyze the clinical characteristics of sepsis in children and assess the risk factors associated with poor prognosis in pediatric sepsis patients to identify timely interventions and improve their outcomes. METHODS This study analyzed the clinical indicators and laboratory results of septic patients hospitalized in the Pediatric Intensive Care Unit of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China, from January 1, 2019, to December 31, 2021. Risk factors for sepsis were identified by logistic regression analyses. RESULTS A total of 355 children with sepsis were enrolled, with 333 children (93.8%) in the good prognosis group, and 22 children (6.2%) in the poor prognosis group. Among them, there were 255 patients (71.8%) in the sepsis group, and 100 patients (28.2%) in the severe sepsis group. The length of hospital stay in the poor prognosis group was longer than that in the good prognosis group (P<0.01). The levels of interleukin 1β (IL-1β) in the poor prognosis group were higher than those in the good prognosis group (P>0.05), and the platelet (PLT), albumin (ALB), and hemoglobin (Hb) levels were lower in the poor prognosis group (P<0.01). The IL-8 levels in the severe sepsis group were higher than those in the sepsis group (P<0.05). Multiple logistic regression analysis suggested that lower Hb levels, ALB levels, peak PLT counts, and higher IL-1β levels were independent risk factors for poor prognosis in children with sepsis. CONCLUSION Lower Hb, ALB, and PLT counts and elevated IL-1β are independent risk factors for poor prognosis in children with sepsis.
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Affiliation(s)
- Yong-Bing Zhu
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tong-Lin Liu
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qi Dai
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shu-Fan Liu
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Peng Xiong
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hao Huang
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi Yuan
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tian-Nan Zhang
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu Chen
- Department of Pediatric Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Liu R, Yu Z, Xiao C, Xu F, Xiao S, He J, Shi Y, Hua Y, Zhou J, Zhang G, Wang T, Jiang J, Xiong D, Chen Y, Xu H, Yun H, Sun H, Pan T, Wang R, Zhu S, Huang D, Liu Y, Hu Y, Ren X, Shi M, Song S, Luo J, He G, Zhang J. Epidemiology and Clinical Characteristics of Pediatric Sepsis in PICUs in Southwest China: A Prospective Multicenter Study. Pediatr Crit Care Med 2024; 25:425-433. [PMID: 38353591 DOI: 10.1097/pcc.0000000000003450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To describe the epidemiological characteristics of pediatric sepsis in Southwest China PICUs. DESIGN A prospective, multicenter, and observational study. SETTING Twelve PICUs in Southwest China. PATIENTS The patients admitted to the PICU from April 1, 2022, to March 31, 2023. The age ranged from 28 days to 18 years. All patients met the criteria of severe sepsis or septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 31 PICUs invited to participate, 12 PICUs (capacity of 292 beds) enrolled patients in the study. During the study period, 11,238 children were admitted to the participating PICUs, 367 (3.3%) of whom met the diagnosis of severe sepsis or septic shock. The most prevalent sites of infection were the respiratory system (55%) and the digestive system (15%). The primary treatments administered to these patients included antibiotics (100%), albumin (61.3%), invasive mechanical ventilation (58.7%), glucocorticoids (55.6%), blood products (51%), gammaglobulin (51%), and vasoactive medications (46.6%). Sepsis-related mortality in the PICU was 11.2% (41/367). Nearly half of the sepsis deaths occurred within the first 3 days of PICU admission (22/41, 53.7%). The mortality rate of septic shock (32/167, 19.2%) was significantly higher than that of severe sepsis (9/200, 4.5%; p < 0.001). The outcomes of a multivariate logistic regression analysis suggested that a higher pediatric Sequential Organ Failure Assessment score, and the use of invasive mechanical ventilation and vasoactive medications were independently associated with PICU mortality in children with sepsis. CONCLUSIONS This report updates the epidemiological data of pediatric sepsis in PICUs in Southwest China. Sepsis is still a life-threatening disease in children.
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Affiliation(s)
- Rong Liu
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhicai Yu
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Changxue Xiao
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Xu
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Shufang Xiao
- Department of Pediatric Critical Care, Kunming Children's Hospital, Kunming, China
| | - Juan He
- Department of Pediatric Critical Care, Kunming Children's Hospital, Kunming, China
| | - Yan Shi
- Department of Pediatric Critical Care, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Liangshan Yi autonomous Prefecture, Sichuan, China
| | - Yuanyuan Hua
- Department of Pediatric Critical Care, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Liangshan Yi autonomous Prefecture, Sichuan, China
| | - Jimin Zhou
- Department of Pediatric Critical Care, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Liangshan Yi autonomous Prefecture, Sichuan, China
| | - Guoying Zhang
- Department of Pediatric Critical Care, Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
| | - Tao Wang
- Department of Pediatric Critical Care, Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
| | - Jianyu Jiang
- Department of Pediatric Critical Care, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China
| | - Daoxue Xiong
- Department of Pediatric Critical Care, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China
| | - Yan Chen
- Department of Pediatric Critical Care, Guizhou Provincial Children's Hospital, Zunyi, Guizhou, China
| | - Hongbo Xu
- Department of Pediatric Critical Care, Guizhou Provincial Children's Hospital, Zunyi, Guizhou, China
| | - Hong Yun
- Department of Pediatric Critical Care, Guizhou Provincial Children's Hospital, Zunyi, Guizhou, China
| | - Hui Sun
- Department of Pediatric Critical Care, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Tingting Pan
- Department of Pediatric Critical Care, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Rui Wang
- Department of Pediatric Critical Care, Yuxi Children's Hospital, Yuxi, Yunnan, China
| | - Shuangmei Zhu
- Department of Pediatric Critical Care, Yuxi Children's Hospital, Yuxi, Yunnan, China
| | - Dong Huang
- Department of Pediatric Critical Care, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yujiang Liu
- Department of Pediatric Critical Care, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yuhang Hu
- Department of Pediatric Critical Care, Sichuan Provincial Maternity and Child Health Hospital, Chengdu, Sichuan, China
| | - Xinrui Ren
- Department of Pediatric Critical Care, Sichuan Provincial Maternity and Child Health Hospital, Chengdu, Sichuan, China
| | - Mingfang Shi
- Department of Pediatric Critical Care, The First People's Hospital of Yibin, Yibin, Sichuan, China
| | - Sizun Song
- Department of Pediatric Critical Care, The First People's Hospital of Yibin, Yibin, Sichuan, China
| | - Jumei Luo
- Department of Pediatric Critical Care, The First People's Hospital of Yibin, Yibin, Sichuan, China
| | - Gang He
- Department of Pediatric Critical Care, Nanchong Central Hospital, Nanchong, China
| | - Juan Zhang
- Department of Pediatric Critical Care, Nanchong Central Hospital, Nanchong, China
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Zhang Y, Li B, Ning B. Evaluating IL-6 and IL-10 as rapid diagnostic tools for Gram-negative bacteria and as disease severity predictors in pediatric sepsis patients in the intensive care unit. Front Immunol 2022; 13:1043968. [PMID: 36544765 PMCID: PMC9760793 DOI: 10.3389/fimmu.2022.1043968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 12/11/2022] Open
Abstract
Background To explore the diagnostic performance of interleukin (IL)-6 and IL-10 in discriminating Gram bacteria types and predicting disease severity in intensive care unit (ICU)-hospitalized pediatric sepsis patients. Method We retrospectively collected Th1/Th2 cytokine profiles of 146 microbiologically documented sepsis patients. Patients were categorized into Gram-positive (G+) or Gram-negative (G-) sepsis groups, and cytokine levels were compared. Subgroup analysis was designed to eliminate the influence of other inflammatory responses on cytokine levels. Results After propensity score matching, 78 patients were matched and categorized according to Gram bacteria types. Compared with G+ sepsis, IL-6 and IL-10 were significantly elevated in G- sepsis (p < 0.05). Spearman test proved the linear correlation between IL-6 and IL-10 (r = 0.654, p < 0.001), and their combination indicators (ratio and differences) were effective in identifying G- sepsis. In the subgroup analysis, such cytokine elevation was significant regardless of primary infection site. However, for patients with progressively deteriorating organ function [new or progressive multiple organ dysfunction syndrome (NPMODS)], differences in IL-6 and IL-10 levels were less significant between G+ and G- sepsis. In the receiver operating characteristic (ROC) curves of the G- sepsis group, the area under the curve (AUC) value for IL-6 and IL-10 was 0.679 (95% CI 0.561-0.798) and 0.637 (95% CI 0.512-0.762), respectively. The optimal cutoff value for diagnosing G- sepsis was 76.77 pg/ml and 18.90 pg/ml, respectively. While for the NPMODS group, the AUC for IL-6 and IL-10 was 0.834 (95% CI 0.766-0.902) and 0.781 (95% CI 0.701-0.860), respectively. Conclusion IL-6 and IL-10 are comparably effective in discriminating G+/G- sepsis in pediatric intensive care unit (PICU) patients. The deteriorated organ function observed in ICU patients reveals that complex inflammatory responses might have contributed to the cytokine pattern observed in severe sepsis patients, therefore confounding the discriminating efficacy of Th1/Th2 cytokines in predicting Gram bacteria types.
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Human FcRn Is a Two-in-One Attachment-Uncoating Receptor for Echovirus 18. mBio 2022; 13:e0116622. [PMID: 35862785 PMCID: PMC9426509 DOI: 10.1128/mbio.01166-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Virus-receptor interactions determine viral host range and tissue tropism. CD55 and human neonatal Fc receptor (FcRn) were found to be the binding and uncoating receptors for some of the echovirus-related enterovirus species B serotypes in our previous study. Echovirus 18 (E18), as a member of enterovirus species B, is a significant causative agent of aseptic meningitis and viral encephalitis in children. However, it does not use CD55 as a critical host factor. We conducted CRISPR/Cas9 knockout screening to determine the receptors and entry mechanisms and identified FcRn working as a dual-function receptor for E18. Knockout of FCGRT and B2M, which encode the two subunits of FcRn, prevented infection by E18 and other echoviruses in the same physiological cluster. We then elucidated the underlying molecular mechanism of receptor recognition by E18 using cryogenic electron microscopy. The binding of the FCGRT subunit to the canyon region rotates the residues around the pocket, triggering the release of the pocket factor as observed for other enterovirus species B members.
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Dang H, Li J, Liu C, Xu F. The Association Between Vitamin E Deficiency and Critically Ill Children With Sepsis and Septic Shock. Front Nutr 2021; 8:648442. [PMID: 34222298 PMCID: PMC8241937 DOI: 10.3389/fnut.2021.648442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Literature is scarce on the assessment of vitamin E status in septic children. We aim to investigate the prevalence of vitamin E deficiency in critically ill children with sepsis and septic shock and its association with clinical features and outcomes. Methods: We compared serum vitamin E status between the confirmed or suspected infection and no infection groups, the sepsis shock and no sepsis shock groups upon pediatric intensive care unit admission. Clinical characteristics were compared in subgroup patients with and without vitamin E deficiency. The association between vitamin E deficiency and septic shock were evaluated using univariate and multivariable methods. Results: 182 critically ill children with confirmed or suspected infection and 114 without infection were enrolled. The incidence of vitamin E deficiency was 30.2% in the infection group and 61.9% in the septic shock subgroup (P < 0.001). Thirty-days mortality in critically ill children with vitamin E deficiency was significantly higher than that without vitamin E deficiency (27.3 vs. 14.2%, P < 0.05). Vitamin E levels were inversely associated with higher pediatric risk of mortality (r = − 0.238, P = 0.001) and cardiovascular sequential organ failure assessment (r = −0.249, p < 0.001) scores in critically ill children with infection. In multivariable logistic regression, vitamin E deficiency showed an independent effect on septic shock (adjusted OR: 6.749, 95%CI: 2.449–18.60, P < 0.001). Conclusion: Vitamin E deficiency is highly prevalent in critically ill children with sepsis and contributed to the septic shock.
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Affiliation(s)
- Hongxing Dang
- Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Jing Li
- Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Chengjun Liu
- Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Feng Xu
- Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
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Humoodi MO, Aldabbagh MA, Salem MM, Al Talhi YM, Osman SM, Bakhsh M, Alzahrani AM, Azzam M. Epidemiology of pediatric sepsis in the pediatric intensive care unit of king Abdulaziz Medical City, Jeddah, Saudi Arabia. BMC Pediatr 2021; 21:222. [PMID: 33962589 PMCID: PMC8103596 DOI: 10.1186/s12887-021-02686-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Pediatric sepsis remains a significant cause of morbidity and mortality worldwide. This study aimed to identify the incidence of sepsis and septic shock among patients admitted to the pediatric intensive care unit (PICU) of a tertiary center in Saudi Arabia. Patients' demographics and risk factors associated with sepsis-related mortality were also investigated. Methods A retrospective cohort study was conducted in the PICU of King Abdulaziz Medical City, Jeddah (KAMC-J). KAMC-J is a tertiary care hospital in the western region of Saudi Arabia. A total of 2389 patients admitted to the PICU of KAMC-J between January 1, 2013 and December 31, 2017 were screened and evaluated for sepsis using The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Results Of the 2389 total admissions to the PICU, 113 patients (4.9%) met the definition of Sepsis-3; 50.4% of the 113 patients met the definition of septic shock. Most patients (66.3%) were less than 6 years old, and 52.2% were male. Eight-five patients (75.2%) had underlying comorbidities. The respiratory system was the most common primary site of infection (57.5%). Bacterial and viral infections were the most common infectious etiology with reported rates of 29.2 and 21.2%, respectively. The median duration of PICU stay was 8 days and the 28-day PICU mortality rate was 23.9%. A Pediatric Sequential Organ Failure Assessment (pSOFA) Score greater than four and a pre-existing percutaneous central venous catheter were associated with a significant increase in mortality, with adjusted odds ratios of 3.6 (95% confidence interval: 1.30–9.93) and 9.27 (95% confidence interval: 1.28–67.29), respectively. Conclusions The incidence of sepsis in our institution is comparable to that reported internationally; however, the mortality rate is higher than that of developed countries. Nationwide studies identifying sepsis epidemiology are needed to improve the outcome of pediatric sepsis. Following international guidelines for central-line insertion and maintenance is of paramount importance. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02686-0.
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Affiliation(s)
- Mohamed O Humoodi
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah, 21556, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Mona A Aldabbagh
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah, 21556, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah, 21556, Saudi Arabia
| | - Maher M Salem
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah, 21556, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Yousef M Al Talhi
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah, 21556, Saudi Arabia.
| | - Sara M Osman
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah, 21556, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Mohammed Bakhsh
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah, 21556, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah, 21556, Saudi Arabia
| | - Abdullah M Alzahrani
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah, 21556, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah, 21556, Saudi Arabia
| | - Maha Azzam
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah, 21556, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah, 21556, Saudi Arabia
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Wang C, Cui Y, Miao H, Sun T, Lu Y, Zhang Y. Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study. Clin Appl Thromb Hemost 2021; 26:1076029620935201. [PMID: 32659109 PMCID: PMC7359640 DOI: 10.1177/1076029620935201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vitronectin (VTN) is a key regulator of coagulation, but clinical relevance of serum VTN in pediatric sepsis remains poorly defined. The aim of this study was to access the value of serum VTN level on pediatric intensive care unit (PICU) admission in children with sepsis. Pediatric patients with sepsis were enrolled from January 2018 to December 2018. The serum VTN levels were determined on PICU admission, and the association of serum VTN level with PICU mortality and organ dysfunction was assessed. Serum VTN levels were significantly lower in nonsurvivors compared with survivors, in patients with septic shock compared with patients with sepsis, or in patients with sepsis-associated acute liver injury (ALI) compared with patients without ALI. Serum VTN level was associated with PICU mortality (odds ratio [OR]: 0.958, 95% CI: 0.927-0.996; P = .010) or ALI (OR: 0.956, 95% CI: 0.915-0.999; P = .046), but not shock (OR: 0.996, 95% CI: 0.977-1.016; P =.716). The area under receiver operating characteristic curve for VTN in predicting the occurrence of ALI during PICU stay and PICU mortality were 0.760 (95% CI: 0.627- 0.893) and 0.737 (95% CI: 0.544-0.931), respectively. Moreover, VTN plus pediatric risk of mortality (PRISM) III had a better clinical utility according to decision curve analysis compared with VTN or PRISM III alone. These findings suggest that serum VTN level is associated with sepsis-associated ALI and PICU mortality, and VTN plus PRISM III is a powerful predictor of PICU mortality in pediatric patients with sepsis, which have a better clinical benefit compared with VTN or PRISM III alone.
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Affiliation(s)
- Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Cui
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huijie Miao
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ye Lu
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
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