河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (2): 177-182.doi: 10.3969/j.issn.1007-3205.2022.02.011

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体温对脓毒症儿童死亡风险的预测价值:一项基于152例脓毒症患儿的回顾性研究

  

  1. 河北省儿童医院重症医学科，河北 石家庄 050031
  • 出版日期:2022-02-25 发布日期:2022-03-03
  • 作者简介:徐梅先（1966-），女，河北石家庄人，河北省儿童医院主任医师，医学学士，从事儿童重症疾病诊治研究。
  • 基金资助:
    河北省重点研发计划儿童脓毒症循证医学研究项目（182777133）

Predictive value of body temperature formortality risk in children with sepsis: A retrospective study of 152 children with sepsis

  1. PICU, Hebei Children′s Hospital， Hebei Province, Shijiazhuang 050031，China
  • Online:2022-02-25 Published:2022-03-03

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摘要： 目的 探讨PICU内脓毒症患儿体温对死亡风险的预测价值。
方法 纳入脓毒症患儿152例，根据入PICU前后24 h内的体温峰值分为超高热组（39.5~41 ℃），发热组（37.5~39.5 ℃），无热组（＜37.5℃ ），比较各组危重症评分、病死率（总体和7 d）、炎性和免疫、器官功能状态等指标。根据入PICU7 d的生存状态分为生存组和死亡组，对照分析两组体温分布、小儿危重症评分等指标。利用Logistic回归分析探讨7 d死亡危险因素。
结果 全部152例脓毒症患儿7 d内死亡占全部死亡82.2%（37/45）。3组7 d病死率分别为36.4%、16.7%和42.9%，以发热组病死率最低（P＜0.05）。超高热组接受血液净化的患儿有11例，占比50.0%；发热组接受血液净化的患儿有34例，占比33.3%；无热组接受血液净化的患儿有3例，占比10.7%。3组接受血液净化的患儿比例比较差异有统计学意义（χ2=9.242，P=0.010）。其中超高热组与发热组的接受血液净化的患儿比例差异无统计学意义（χ2=0.109，P=0.741）；超高热组的接受血液净化的患儿比例高于无热组，差异有统计学意义（χ2=9.432，P=0.002）；发热组的接受血液净化的患儿比例高于无热组，差异有统计学意义（χ2=5.520，P=0.019）。3组相关炎症指标（白细胞、C反应蛋白、降钙素原、初始淋巴细胞）比较差异无统计学意义（P＞0.05），但48~72 h淋巴细胞数值3组差异有统计学意义（P＜0.05），其中无热组和超高热组数值低于发热组，且有统计学意义（P＜0.05）。3组肌酸激酶（creatine kinase ，CK）异常率、肌酸激酶同工酶（creatine kinase MB ，CK-MB）异常率、肌酐（creatinine，Cr）异常率和乳酸脱氢酶（lactate dehydrogenase ，LDH）异常率无统计学意义（P＞0.05），超高热组和发热组的ALT异常率低于无热组，差异有统计学意义（P＜0.05）。将所有患者根据7 d的生存情况分为生存组和死亡组。死亡组以无热组患儿占比最高，达40.5%；而生存组以发热组患儿占比最高，达76.5%（P＜0.001）。7 d生存组的小儿危重症评分高于7 d死亡组、48~72 h淋巴细胞绝对值高于死亡组（P＜0.05），2组C反应蛋白和降钙素原比较差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示，小儿危重病例评分、48~72 h淋巴细胞绝对值是7 d病死的危险因素（P＜0.05）。
结论 PICU脓毒症患儿发热组占比高，且发热组相比超高热组和无热组存活率更高，但体温并不是死亡的独立危险因素。


关键词: 脓毒症, 体温, 病死率

Abstract: Objective To explore the predicative value of body temperature for mortality risk of children with sepsis in PICU. 
Methods A total of 152 children with sepsis were included and divided into three groups based on the body temperature at 24h before and after PICU admission: ultrahyperpyrexia(39.5-41 ℃) group，fever(37.5-39.5 ℃) group and apyrexia(＜37.5 ℃) group. Pediatric critical illness score(PCIS), mortality rate(overall and at 7 d after admission), inflammation and immune function, multiple organs function were compared.They were also divided into the survival group and the death group according to condition at 7 d after PICU admission, and temperature distribution and PCIS score were compared. The risk factors of 7-day mortality was analyzed by Logistic regression analysis. 
Results Of 152 children with sepsis,the number of children that died within 7 d accounted for 82.2%(37/45). The 7-day mortality of the three groups were 36.4%, 16.7% and 42.9%, respectively, with the lowest mortality rate in the fever group(P＜0.05). In the ultrahyperpyrexia group, 11 children received blood purification, accounting for 50.0%; In the fever group, 34 children received blood purification, accounting for 33.3%; In the apyrexia group, 3 children received blood purification, accounting for 10.7%. There was significant difference in the proportion of children receiving blood purification among the three groups(χ2=9.242, P=0.010). There was no significant difference in the proportion of children receiving blood purification between ultrahyperpyrexia group and fever group(χ2 =0.109, P=0.741). The proportion of children receiving blood purification in the ultrahyperpyrexia group was higher than that in the apyrexia group, and the difference was statistically significant(χ2 =9.432, P=0.002). The proportion of children receiving blood purification in the fever group was higher than that in the apyrexia group, and the difference was statistically significant(χ2=5.520, P=0.019). There was no significant difference in the related inflammatory indexes［white blood cells(WBC), C-reactive protein(CRP), procalcitonin(PCT) and naive lymphocytes］ among three groups(P＞0.05). However, there was significant difference in the lymphocyte count of the three groups at 48-72 h(P＜0.05), and the values of apyrexia group and ultrahyperpyrexia group were lower than those of fever group(P＜0.05). The abnormal rates of CK, CK-MB, Cr and LDH in the three groups were not statistically significant(P＞0.05). The abnormal rates of ALT in the ultrahyperpyrexia group and fever group were lower than those in the apyrexia group(P＜0.05). All patients were divided into survival group and death group according to 7-day survival. In the death group, the proportion of children without fever was the highest, up to 40.5%; In the survival group, the proportion of children with fever was the highest, up to 76.5%(P＜0.001). The PCIS score of children in the survival group was higher than that in the death group, and the absolute lymphocyte count at 48-72 h was higher than that in the death group(P＜0.05). There was no significant difference in CRP and PCT between two groups(P＞0.05). Multivariate Logistic regression analysis showed that PCIS score in children and the absolute lymphocyte count at 48-72 h were the risk factors of death(P＜0.05). 
Conclusion The proportion of septic children with fever is high in PICU, and children with fever have a higher survival rate than those with ultrahyperpyrexia or with apyrexia. However, body temperature is not the independent risk factor for mortality.  


Key words: sepsis, body temperature, mortality

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