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

Abstract

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

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.

Figures/Tables 4

References 30

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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

Predictive value of urinary CXCL10 for mortality risk of critically ill children in PICU

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