补体C3对儿童脓毒症患者预后的预测价值

Value of complement component 3 in predicting the prognosis of children with sepsis

摘要:

目的 分析补体C3在脓毒症患儿中的变化情况及其与脓毒症病情严重程度的关系，探讨补体C3对脓毒症患儿死亡的预测价值。方法 回顾性收集2019年11月—2021年9月湖南省儿童医院重症医学科收治的529例脓毒症患儿为研究对象。按诊断脓毒症后28 d预后情况分为存活组（n=471）和死亡组（n=58）；按入院诊断脓毒症24 h内补体C3的中位数（0.77 g/L）分为C3正常组（n=273）和C3降低组（n=256）。比较各组间的临床及实验室指标差异，分析补体C3对脓毒症患儿死亡的预测价值。结果 死亡组补体C3水平较存活组明显降低（P<0.05）。多因素logistic回归分析显示，儿童快速序贯器官衰竭评分（pediatric Sequential Organ Failure Assessment, p-SOFA）得分高和补体C3低与脓毒症患儿死亡密切相关（P<0.05）。受试者操作特征曲线分析显示，p-SOFA与补体C3的联合预测模型曲线下面积为0.852，高于p-SOFA、补体C3单项指标的预测价值（P<0.05）。结论 补体C3可作为脓毒症患儿病情严重程度及预后的评价指标；p-SOFA联合补体C3对脓毒症患儿死亡有良好的预测价值。

Abstract:

Objective To investigate changes in complement component 3 (C3) levels in children with sepsis and its correlation with the severity of sepsis and to explore the significance of C3 in predicting mortality in children with sepsis.Methods A retrospective analysis was conducted on 529 children with sepsis who were admitted to the Pediatric Intensive Care Unit in Hunan Children's Hospital between November 2019 and September 2021. The children were categorized into two groups based on their prognosis at day 28 after sepsis diagnosis: the survival group (n=471) and the death group (n=58). Additionally, the children were divided into normal C3 group (n=273) and reduced C3 group (n=256) based on the median C3 level (0.77 g/L) within 24 hours of admission. Clinical data and laboratory markers were compared between the groups, and assess the predictive value of C3 levels in relation to sepsis-related mortality.Results The death group exhibited significantly lower C3 levels compared to the survival group (P<0.05). Multivariate logistic regression analysis revealed that higher pediatric Sequential Organ Failure Assessment (p-SOFA) scores and lower C3 levels were closely associated with sepsis-related mortality (P<0.05). The receiver operating characteristic curve (ROC) analysis demonstrated that combination of p-SOFA scores and C3 levels yielded an area under the ROC curve of 0.852, which was higher than that of each indicator alone (P<0.05).Conclusions C3 can serve as an indicator to assess the severity and prognosis of sepsis in children. The combination of p-SOFA scores and C3 levels holds good predictive value for mortality in children with sepsis.