尿CXCL10水平对PICU重症患儿死亡风险的预测价值

doi:10.12372/jcp.2024.23e0856

摘要/Abstract

摘要：

目的探讨尿C-X-C基序趋化因子10（CXCL10）水平对重症患儿住儿科重症监护病房（PICU）期间死亡风险的预测价值。方法选择2016年9月至12月以及2017年12月至2018年1月PICU收治的323例重症患儿作为研究对象。根据入住PICU期间转归情况分为生存组（295例）和死亡组（28例），比较组间患儿临床特征。采用酶联免疫吸附法检测患儿入住PICU第1周尿CXCL10水平的动态变化。运用多因素逐步线性回归分析明确尿CXCL10水平与临床变量的相关性。多因素logistic回归分析评估在校正混杂因素后尿CXCL10与病死率的关系，采用受试者工作特征曲线下面积（AUC）评估尿CXCL10对重症患儿病死率的预测价值。结果死亡组尿CXCL10初始值和最大值均明显高于生存组（P<0.05）。多因素线性和logistic回归分析均显示尿CXCL10的初始值及最大值与死亡显著相关（P<0.05）。尿CXCL10初始和最大值预测重症患儿死亡的AUC值分别为0.780（95%CI：0.689~0.872，P<0.001）、0.846（95%CI：0.769~0.923，P<0.001）。结论尿CXCL10是重症患儿死亡的独立预测指标。

关键词: 死亡风险, 尿CXCL10, 预测价值, 儿童

Abstract:

Objective To investigate the predictive value of urinary CXC motif chemokine ligand 10 (uCXCL10) in the risk of death in critically ill children during their stay in the pediatric intensive care unit (PICU). Methods A total of 323 critically ill children admitted to PICU from September to December 2016 and from December 2017 to January 2018 were selected as the research objects. The patients were divided into survival group (295 cases) and death group (28 cases) according to the outcome during hospitalization in PICU, and the clinical characteristics of the children were compared between the groups. The uCXCL10 levels were serially measured during the first week after PICU admission using an enzyme-linked immunosorbent assay. Stepwise multivariate linear regression analysis were used to determine the correlation between uCXCL10 levels and clinical variables. Multivariate logistic regression analysis were performed to investigate the association of uCXCL10 with mortality after adjusting for confounders. The area under the ROC curve (AUC) was calculated to assess the predictive value of uCXCL10 in mortality of critically ill children. Results The initial and maximum values of uCXCL10 in the death group were significantly higher than those in the survival group (P<0.05). Both stepwise multivariate linear regression and multivariate logistic regression analysis showed that the initial and maximum values of uCXCL10 were significantly associated with mortality (P<0.05). The AUC values of initial and maximum uCXCL10 for predicting death in critically ill children were 0.780 (95%CI: 0.689-0.872, P<0.001) and 0.846 (95%CI: 0.769-0.923, P<0.001), respectively. Conclusion The uCXCL10 is an independent predictor of death in critically ill children.

Key words: mortality risk, urinary CXC motif chemokine ligand 10, predictive value, child

冯恋, 胡俊龙, 黄慧, 李晓忠, 李艳红. 尿CXCL10水平对PICU重症患儿死亡风险的预测价值[J]. 临床儿科杂志, 2024, 42(7): 631-636.

FENG Lian, HU Junlong, HUANG Hui, LI Xiaozhong, LI Yanhong. Predictive value of urinary CXCL10 for mortality risk of critically ill children in PICU[J]. Journal of Clinical Pediatrics, 2024, 42(7): 631-636.

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项目	存活组（n=295）	死亡组（n=28）	统计量	P
年龄[M(P₂₅~P₇₅)]/月	17.0(3.1~56.0)	20.5(8.4~71.8)	Z=1.23	0.194
体重[M(P₂₅~P₇₅)]/kg	11.0(6.6~18.0)	12.5(7.9~23.8)	Z=1.03	0.303
性别(男)[n(%)]	197(66.8)	21(75.0)	χ²=0.78	0.375
PRISM Ⅲ[M(P₂₅~P₇₅)]/分	3(0~8)	14(7~28.8)	Z=5.69	<0.001
AKI[n(%)]	34(11.5)	15(53.6)	χ²=31.94	<0.001
AKI 1期[n(%)]	15(5.1)	6(21.5)	χ²=11.88	0.003
AKI 2期[n(%)]	13(4.4)	0(0.0)
AKI 3期[n(%)]	6(2.0)	9(32.1)
脓毒症[n(%)]	107(36.3)	14(50.0)	χ²=2.06	0.151
MODS[n(%)]	16(5.4)	18(64.3)	χ²=87.93	<0.001
休克/DIC[n(%)]	21(7.1)	9(32.1)	χ²=16.15	<0.001
MV[n(%)]	58(19.7)	25(89.3)	χ²=64.92	<0.001
RRT[n(%)]	12(4.1)	4(14.3)	χ²=3.71	0.054
正性肌力药[n(%)]	22(7.5)	9(32.1)	χ²=15.23	<0.001
利尿剂[n(%)]	25(8.5)	12(42.9)	χ²=26.51	<0.001
激素[n(%)]	161(54.6)	21(75.0)	χ²=4.34	0.037
抗生素[n(%)]	231(78.3)	24(85.7)	χ²=0.85	0.358
PICU时长[M(P₂₅~P₇₅)]/ h	87.5(46.0~148.0)	167.8(63.0~420.0)	Z=2.76	0.006
uCXCL10初始值/uCr[M(P₂₅~P₇₅)]/ng·mg^-1	0.09(0.04~0.25)	0.80(0.14~2.98)	Z=4.90	<0.001
uCXCL10最大值/uCr[M(P₂₅~P₇₅)]/ng·mg^-1	0.11(0.05~0.35)	2.04(0.45~3.75)	Z=6.50	<0.001

因素	uCXCL10初始值			uCXCL10最大值
因素	β	S.E.	P	β	S.E.	P
体重	NA	NA	NA	-0.009	0.003	0.005
AKI分期	NA	NA	NA	0.124	0.051	0.015
脓毒症	0.189	0.076	0.013	0.192	0.072	0.008
休克/DIC	0.384	0.130	0.003	0.406	0.127	0.001
临床结局	0.682	0.132	<0.001	0.733	0.132	<0.001

因素	OR	95%CI	P	AOR	95%CI	P
尿CXCL10初始值	4.295	2.458~7.503	<0.001	4.079^1）	1.676~9.929	0.002
尿CXCL10最大值	6.118	3.343~11.453	<0.001	5.421^1）	2.114~13.904	<0.001