Procalcitonin and cytokine levels: Relationship to organ failure and mortality in pediatric septic shock
Procalcitonin and cytokine levels: Relationship to organ failure and mortality in pediatric septic shock
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DOI：
10.1097/00003246-200007000-00068
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发表时间：
2000-07-01
影响因子：
8.8
通讯作者：
Murdoch, IA
中科院分区：
文献类型：
--
作者：
Hatherill, M;Tibby, SM;Murdoch, IA
背景资料：降钙素原（PGT）是细菌性脓毒症的标志物，也可作为感染炎症反应的介质，从而影响预后。目的：探讨PCT、白细胞介素（IL）-10、肿瘤坏死因子（TNF）与小儿脓毒症休克中器官衰竭和死亡率的关系。一所大学医院的16个床位的儿科重症监护病房。患者：共75名感染性休克儿童，中位年龄为43.1个月（范围，0.1-192个月）。排除接受抗生素治疗>24小时的儿童。共有37例（49%）患者患有脑膜炎球菌病，72例（96%）患者需要机械通气。干预措施：记录儿科死亡风险（PRISM）评分、多器官系统衰竭（MOSF）评分、通气时间、ICU住院时间和结局。PCT、IL-10和TNF在进入重症监护室时进行测量。39例患者（52%）在0小时和24小时连续PCT水平可用。结果：观察到的死亡率为21/75（28%）。数据为中位数（范围）。MOSF评分较高的儿童入院时PCT（p = .0002）和TNF水平（p =.0001）较高。在存活者和非存活者中，入院时PCT分别为82 ng/mL vs. 273 ng/mL（p = .03），IL-10分别为62 pg/mL vs. 534 pg/mL（p =.03），TNF分别为76 pg/mL vs. 480 pg/mL（p = .001）。PCT、IL-10和TNF的死亡率受试者工作特征曲线下面积分别为0.73、0.67和0.76，而PRISM评分为0.83。与PCT随后下降的儿童相比，这些儿童的IL-10（p = 0.03）和TNF（p = 0.03）入院水平较高。虽然前者没有更高的中位PRISM（p = .28）或MOSF评分（p = .19），观察到的死亡率为44%（7/16）与9%（2/23）相比（p = .02）。结论：入院PCT，如TNF和IL-10，与脓毒性休克儿童的器官衰竭和死亡率的严重程度有关。治疗24小时后PCT下降可能具有良好的预后意义。
Background: Procalcitonin (PGT), a marker of bacterial sepsis, may also act as a mediator of the inflammatory response to infection, and thus influence outcome.Objective: To investigate the relationship between PCT, interleukin (IL)-10, tumor necrosis factor (TNF), organ failure, and mortality in pediatric septic shock.Design: Prospective observational study,Setting.. A 16-bed pediatric intensive care unit of a university hospital.Patients: A total of 75 children with septic shock having a median age of 43.1 months (range, 0.1-192 months). Children who had received antibiotics for >24 hrs were excluded. A total of 37 patients (49%) had meningococcal disease, and 72 patients (96%) required mechanical ventilation.Interventions: The pediatric risk of mortality (PRISM) score, multiple organ system failure (MOSF) score, duration of ventilation, length of ICU stay, and outcome were recorded. PCT, IL-10, and TNF were measured at admission to the intensive care unit. Sequential PCT levels were available at 0 hrs and 24 hrs in 39 patients (52%).Results: Observed mortality was 21/75 (28%). Data are median (range). The admission PCT (p = .0002) and TNF levels (p =.0001) were higher in children with higher MOSF scores. in survivors and nonsurvivors, the admission PCT was 82 ng/mL vs. 273 ng/mL (p = .03), IL-10 was 62 pg/mL vs. 534 pg/mL (p =,03), and TNF was 76 pg/mL vs. 480 pg/mL (p = .001), respectively. Area under the mortality receiver operating characteristic curve was 0.73 for PCT, 0.67 for IL-10, and 0.76 for TNF, compared with 0.83 for the PRISM score.Of 39 children, 16 (41%) with sequential PCT measurements showed no fall in PCT after 24 hrs treatment. These children had higher admission levels of IL-10 (p = .03), and TNF (p =.03) compared with children who demonstrated a subsequent fall in PCT. Although the former did not have a higher median PRISM (p = .28) or MOSF score (p = .19), observed mortality was 44% (7 of 16) compared with 9% (2 of 23) (p = .02).Conclusion: The admission PCT, like TNF and IL-10, is related to the severity of organ failure and mortality in children with septic shock. A fall in PCT after 24 hrs of treatment may have favorable prognostic significance.