Citation: | ZHANG Qiong, LUO Qilin, WANG Kai. Application values of serum procalcitonin, anti-thrombin Ⅲ, D-dimer and four items of coagulation test in early diagnosis of pediatric sepsis[J]. Journal of Clinical Medicine in Practice, 2024, 28(21): 43-47. DOI: 10.7619/jcmp.20242011 |
To investigate the values of serum procalcitonin (PCT), anti-thrombin Ⅲ (AT-Ⅲ), D-dimer (D-D), fibrinogen (FIB), thrombin time (TT), activated partial thromboplastin time (APTT), and prothrombin time (PT) in the early diagnosis of pediatric sepsis.
A total of 82 children with sepsis in the Pediatric Intensive Care Unit (PICU) of General Hospital of Hunan University of Medicine from June 2020 to June 2023 were selected as sepsis group. Meanwhile, 90 children with respiratory tract infections in the general ward were included in general infection group, and 100 healthy children in the Department of Pediatric Health were selected as control group. The levels of serum PCT, AT-Ⅲ, D-D, FIB, TT, APTT and PT were compared among the three groups.
Compared with the general infection group and the control group, the sepsis group had significantly higher serum PCT and D-D levels, prolonged TT, APTT and PT in the four-items of coagulation test, and reduced AT-Ⅲ and FIB levels (P < 0.05). The areas under the curve (AUCs) for the diagnosis of pediatric sepsis by serum PCT, AT-Ⅲ, D-D, PT, APTT, TT and FIB levels were 0.949, 0.174, 0.911, 0.869, 0.855, 0.834 and 0.242 respectively; among these indexes, serum PCT showed the highest diagnostic value, with the maximum Youden index at a cut-off value of 0.62 μg/L, and the diagnostic sensitivity and specificity were 86.6% and 79.0% respectively. The AUC for the combined diagnosis of pediatric sepsis by the seven indicators was 0.966.
The detection of serum PCT, AT-Ⅲ, D-D and four items of coagulation test is of great value in the early diagnosis and differential diagnosis of pediatric sepsis.
[1] |
WILLIS R, HESLOP O, BODONAIK N, et al. Morbidity, mortality and antimicrobial resistance of pneumococcal infections in the Jamaican paediatric and adult populations[J]. Hum Antibodies, 2019, 27(3): 155-160. doi: 10.3233/HAB-180361
|
[2] |
FLEISCHMANN-STRUZEK C, GOLDFARB D M, SCHLATTMANN P, et al. The global burden of paediatric and neonatal sepsis: a systematic review[J]. Lancet Respir Med, 2018, 6(3): 223-230. doi: 10.1016/S2213-2600(18)30063-8
|
[3] |
KISSOON N, CARAPETIS J. Pediatric sepsis in the developing world[J]. J Infect, 2015, 71(Suppl 1): S21-S26.
|
[4] |
中华医学会儿科学分会急救学组, 中华医学会急诊医学分会儿科学组, 中国医师协会儿童重症医师分会. 儿童脓毒性休克(感染性休克)诊治专家共识(2015版)[J]. 中华儿科杂志, 2015, 53(8): 576-580. doi: 10.3760/cma.j.issn.0578-1310.2015.08.007
|
[5] |
中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 急性上呼吸道感染基层诊疗指南(实践版·2018)[J]. 中华全科医师杂志, 2019, 18(5): 427-430. doi: 10.3760/cma.j.issn.1671-7368.2019.05.006
|
[6] |
WEISS S L, BALAMUTH F, HENSLEY J, et al. The epidemiology of hospital death following pediatric severe sepsis: when, why, and how children with sepsis die[J]. Pediatr Crit Care Med, 2017, 18(9): 823-830. doi: 10.1097/PCC.0000000000001222
|
[7] |
INNOCENTI F, GORI A M, GIUSTI B, et al. Prognostic value of sepsis-induced coagulation abnormalities: an early assessment in the emergency department[J]. Intern Emerg Med, 2019, 14(3): 459-466. doi: 10.1007/s11739-018-1990-z
|
[8] |
丁锋, 张清会, 徐慧, 等. PCT与CRP和CD64指数对细菌感染慢性阻塞性肺疾病急性加重期患者诊断及指导治疗的意义[J]. 中华医院感染学杂志, 2017, 27(10): 2198-2201.
|
[9] |
MADABUSHI R, RAJAPPA G C, THAMMANNA P P, et al. Fascia iliaca block vs intravenous fentanyl as an analgesic technique before positioning for spinal anesthesia in patients undergoing surgery for femur fractures-a randomized trial[J]. J Clin Anesth, 2016, 35: 398-403. doi: 10.1016/j.jclinane.2016.09.014
|
[10] |
PODDAR B, GURJAR M, SINGH S, et al. Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock-a pilot study[J]. J Crit Care, 2016, 36: 230-233. doi: 10.1016/j.jcrc.2016.07.022
|
[11] |
罗辑. 降钙素原对危重症患者合并脓毒症早期诊断及预后预测的意义及价值分析[J]. 中国当代医药, 2021, 28(9): 65-67, 71.
|
[12] |
SEMERARO F, AMMOLLO C T, CAIRONI P, et al. Low D-dimer levels in sepsis: Good or bad?[J]. Thromb Res, 2019, 174: 13-15. doi: 10.1016/j.thromres.2018.12.003
|
[13] |
WANG Q, TIAN X B, LIU W, et al. Procalcitonin as a diagnostic indicator for systemic bacterial infections in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis[J]. J Dermatol, 2018, 45(8): 989-993. doi: 10.1111/1346-8138.14488
|
[14] |
古丽娣. D-二聚体水平与脓毒症患者预后的临床相关研究[J]. 黑龙江中医药, 2021, 50(5): 21-22.
|
[15] |
LUPU F, KINASEWITZ G, DORMER K. The role of endothelial shear stress on haemodynamics, inflammation, coagulation and glycocalyx during sepsis[J]. J Cell Mol Med, 2020, 24(21): 12258-12271. doi: 10.1111/jcmm.15895
|
[16] |
李莹欣, 铁诗瑒, 杨雪, 等. 非抗凝肝素衍生物对脓毒症小鼠高凝状态改善作用机制研究[J]. 中国临床药理学杂志, 2022, 38(18): 2187-2191.
|
[17] |
黄业, 易文枫, 黄贵. 脓毒症患者凝血功能指标与预后的关系[J]. 临床医学研究与实践, 2020, 5(23): 115-116.
|
[18] |
WEISS S L, PETERS M J, ALHAZZANI W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children[J]. Pediatr Crit Care Med, 2020, 21(2): e52-e106. doi: 10.1097/PCC.0000000000002198
|
[19] |
HAYAKAWA M, YAMAKAWA K, KUDO D, et al. Optimal antithrombin activity threshold for initiating antithrombin supplementation in patients with sepsis-induced disseminated intravascular coagulation: a multicenter retrospective observational study[J]. Clin Appl Thromb Hemost, 2018, 24(6): 874-883. doi: 10.1177/1076029618757346
|
[20] |
MATSUBARA T, YAMAKAWA K, UMEMURA Y, et al. Significance of plasma fibrinogen level and antithrombin activity in sepsis: a multicenter cohort study using a cubic spline model[J]. Thromb Res, 2019, 181: 17-23. doi: 10.1016/j.thromres.2019.07.002
|
[21] |
WALBORN A, WILLIAMS M, FAREED J, et al. International normalized ratio relevance to the observed coagulation abnormalities in warfarin treatment and disseminated intravascular coagulation[J]. Clin Appl Thromb Hemost, 2018, 24(7): 1033-1041. doi: 10.1177/1076029618772353
|
[22] |
项曦, 洪倩, 楼帅, 等. 活化部分凝血活酶时间凝血酶原时间及凝血因子8活性在子宫功能障碍性出血患者中的表达及意义[J]. 中国妇幼保健, 2024, 39(2): 235-238.
|
[23] |
MUSTAFICS, BRKICS, PRNJAVORAC B, et al. Diagnostic and prognostic value of procalcitonin in patients with sepsis[J]. Med Glasnik, 2018, 15(2): 93-100. doi: 10.17392/963-18
|
[24] |
袁鼎山, 李爱林. PCT、IL-6及CRP对脓毒症的诊断价值[J]. 中国现代医学杂志, 2018, 28(32): 86-90.
|