Heart-type fatty acid-binding protein predict the prognosis in pediatric patients with sepsis and septic shock
10.3760/cma.j.issn.1671-0282.2018.06.007
- VernacularTitle:心型脂肪酸结合蛋白在儿童严重脓毒症及脓毒性休克中的意义
- Author:
Yiping ZHOU
1
;
Xi XIONG
;
Chunxia WANG
;
Huijie MIAO
;
Yun CUI
;
Yucai ZHANG
Author Information
1. 上海交通大学附属儿童医院重症医学科上海交通大学儿科危重病研究所
- Keywords:
H-FABP;
Severe sepsis;
Septic shock;
28 day mortality;
Child
- From:
Chinese Journal of Emergency Medicine
2018;27(6):605-610
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the prognostic value of heart-type fatty acid-binding protein (H-FABP)in pediatric patients with severe sepsis and septic shock. Methods A prospective observational study was carried out in consecutive pediatric patients with severe sepsis and septic shock admitted between October 2016 and September 2017. Data of patient's demographics, clinical characteristics, blood biochemical markers including H-FABP, N-terminal B-type natriuretic peptide (NT-BNP), creatine kinase isoenzyme(CK-MB) and cardiac troponin I(cTnl), Lactate dehydrogenase (LDH) and Lactic acid (Lac), complications and survival status were collected and analyzed. The receiver operating characteristic (ROC) curve was mainly used to evaluate the power of a continuous variable for 28-day survival rate, and Kaplan-Meier analysis was used to compare 28-day survival curves in pediatric patients with severe sepsis and septic shock. Results A total of 78 cases with severe sepsis (n=33) and septic shock (n=45) were enrolled in this study. There were 64 survival cases and 14 non-survivor within 28 days after admission. The plasma levels of H-FABP, NT-BNP, LDH, CK-MB were significantly higher in non-survivor than those in survivor (49.10±65.14) vs. (5.06±4.29) ng/ml; (131.63±130.91) vs. (37.30±29.24) U/L; (2 403.88±415.97) vs.(2 971.57±279.49) U/L; (5 872.93±6 383.28)pg/ml vs. (1 656.86±2 715.73) pg/ml; respectively, all P＜0.05). The area under the receiver operating characteristic curve (AUC) of H-FABP was 0.858 (95％ confidence interval [CI]: 0.716-1.0; P=0.002), which was superior to CK-MB (AUC=0.841,95％CI: 0.696-0.986; P=0.003);LDH (AUC=0.818, 95％CI: 0.610-1.000; P =0.005) and NT-BNP (AUC=0.728, 95％CI: 0.535-0.921;P=0.045). A Kaplan-Meier curve showed a significantly lower survival rate in patients with H-FABP greater than 7.7 ng/mL than the patients with H-FABP less than 7.7 ng/mL. Conclusions H-FABP is an effective prognostic indicator in pediatric patients with severe sepsis and septic shock with superiority to traditional myocardial enzyme.
