A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis.
A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis.
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DOI：
10.1097/pcc.0000000000001029
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发表时间：
2017-02
期刊：
影响因子：
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通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators
中科院分区：
文献类型：
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作者：
Carcillo JA;Sward K;Halstead ES;Telford R;Jimenez-Bacardi A;Shakoory B;Simon D;Hall M;Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators
我们测试了一种假设，即C反应蛋白(CRP)和铁蛋白为基础的全身性炎症反应表可以跟踪儿童严重脓毒症的死亡风险。前瞻性队列研究有100例严重脓毒症住院病例的三级儿科重症监护病房儿童入选。在脓毒症的第二天和每两周采集血样进行生物标志物批次分析。用C反应蛋白和铁蛋白阈值编制了2×2列联表。在使用Youden指数进行第一次采样(n=100)时，发现C反应蛋白为4.08 mg/dL，铁蛋白为1,980 ng/m L是预测结果的最佳界值。“高危”C反应蛋白≥4.08 mg/dL和铁蛋白≥1,980 ng/ml类别的重症监护室死亡率(6/13，46.15%)高于“中危”C反应蛋白≥4.08 mg/dL和铁蛋白+lt；1,980 ng/m l或C-反应蛋白4.08 mg/dL和铁蛋白≥1,980 ng/m L类别(2/43，4.65%)，以及“低风险”C反应蛋白和铁蛋白；1,980 ng/ml类别(0/44，0%)(OR36.43[95%可信区间：6.16~215.21])。“高危”类别还与免疫麻痹(OR4.47[95%可信区间1.34~14.96])和巨噬细胞激活综合征(OR24.20[95%可信区间5.50~106.54])的发生有关。63名儿童接受了连续的血液采样；那些最初属于低风险类别的儿童(n=24)和后来转移到低风险类别的儿童(n=19)都存活了下来，而那些仍然处于风险类别的儿童的死亡率增加了(7/20=35%；p<；0.05)。基于C反应蛋白和铁蛋白的列联表有效地评估了死亡风险。对于患有严重脓毒症的儿童，将全身炎症降低到4.08 mg/dL的联合阈值以下和1,980 ng/mL的铁蛋白似乎是理想的反应。
We tested the hypothesis that a c-reactive protein (CRP) and ferritin based systemic inflammation contingency table can track mortality risk in pediatric severe sepsis. Prospective cohort study Tertiary Pediatric Intensive Care Unit Children with 100 separate admission episodes of severe sepsis were enrolled. Blood samples were attained on day two of sepsis and bi-weekly for biomarker batch analysis. A 2 × 2 contingency table using CRP and ferritin thresholds was developed. A CRP of 4.08 mg/dL and a ferritin of 1,980 ng/mL were found to be optimal cutoffs for outcome prediction at first sampling (n = 100) using the Youden Index. PICU mortality was increased in the ‘High risk’ CRP ≥ 4.08 mg/dL and Ferritin ≥ 1,980 ng/mL category (6/13, 46.15%) compared to the ‘Intermediate risk’ CRP ≥ 4.08 mg/dL and Ferritin < 1,980 ng/mL or CRP < 4.08 mg/dL and Ferritin ≥ 1,980 ng/mL categories (2/43, 4.65%), and the ‘Low risk’ CRP < 4.08 mg/dL and Ferritin < 1,980 ng/mL category (0/44, 0%) (OR 36.43 [95% CI: 6.16–215.21]). The ‘High risk’ category was also associated with the development of Immunoparalysis (OR 4.47 [95% CI 1.34–14.96]) and Macrophage Activation Syndrome (OR 24.20 [95% CI 5.50–106.54]). Sixty three children underwent sequential blood sampling; those who were initially in the ‘Low risk’ category (n = 24) and those who subsequently migrated to (n =19) to the ‘Low risk’ category all survived, whereas those who remained in the ‘At risk’ categories had increased mortality (7/20 = 35%; p < 0.05). A CRP and ferritin based contingency table effectively assessed mortality risk. Reduction in systemic inflammation below a combined threshold CRP of 4.08 mg/dL and ferritin of 1,980 ng / mL appeared to be a desired response in children with severe sepsis.