Objective:To explore the value of plasma soluble leukocyte differentiation antigen 14 subtype(Presepsin) combined with neutrophil gelatinase associated lipocalin(NGAL) in the early diagnosis and prognosis of sepsis in children.Methods:A total of 94 children with sepsis admitted to our hospital from June 2017 to October 2020 were selected, 41 children with shock were classified as septic shock group, and 53 children without shock were classified as sepsis group.Another 41 healthy children in our hospital during the same period were selected as the control group.The plasma levels of Presepsin, NGAL, procalcitonin(PCT) and C-reactive protein(CRP)were detected in three groups.The pediatric critical illness score and sequential organ failure(SOFA)score of children with sepsis were recorded.According to the mortality of the children within 28 days of admission, they were divided into survival group( n=75)and death group( n=19). The plasma levels of Presepsin, NGAL, PCT and CRP, pediatric critical illness score and SOFA score were compared between the survival group and the death group.Pearson test and receiver operating characteristic curve were used to analyze the correlation between plasma Presepsin, NGAL and pediatric critical illness score, SOFA score, and the predictive value of early diagnosis and prognosis of sepsis in children. Results:The levels of plasma Presepsin, NGAL, PCT and CRP in sepsis group and septic shock group were higher than those in control group, and those in septic shock group were higher than those in sepsis group( P<0.05). The plasma levels of Presepsin, NGAL, PCT, CRP and SOFA scores in death group were higher than those in survival group, and the pediatric critical illness score in death group was lower than that in survival group( P<0.05). Plasma Presepsin and NGAL were negatively correlated with pediatric critical illness score( r=-0.676, P<0.001; r=-0.664, P<0.001), and positively correlated with SOFA score( r=0.781, P<0.001; r=0.749, P<0.001). When the plasma Presepsin level was 468.91 ng/L, the sensitivity of area under curve(AUC) for sepsis diagnosis was 85.6% and the specificity was 77.5%.When the plasma NGAL level was 38.94 ng/mL, the sensitivity of AUC for sepsis diagnosis was 82.4%, and the specificity was 65.8%.The AUC of plasma Presepsin combined with NGAL for early diagnosis of sepsis was 0.912(95% CI 0.865 to 0.959), which was higher than of plasma Presepsin of 0.857(95% CI 0.785 to 0.928) and the AUC of NGAL of 0.761(95% CI 0.680 to 0.841). When the plasma Presepsin level was 816.92 ng/L, the sensitivity for predicting the prognosis of sepsis was 73.2% and the specificity was 76.1%.When the plasma NGAL level was 51.27 ng/mL, the sensitivity for predicting the prognosis of sepsis was 67.4% and the specificity was 68.0%.The AUC of plasma Presepsin combined with NGAL to predict the prognosis of sepsis was 0.891(95% CI 0.816 to 0.966), which was higher than the AUC of plasma Presepsin of 0.795(95% CI 0.698 to 0.892) and NGAL of AUC 0.714(95% CI 0.577 to 0.851). Conclusion:Clinical detection of plasma Presepsin and NGAL levels is helpful to early diagnosis of sepsis and judge the severity of the disease in children, which has guiding significance in evaluating the prognosis, and is beneficial to improve the prognosis.

Objective:To evaluate the relationship between preoperative free thyroxine (FT4) levels and the risk of new-onset atrial fibrillation (AF) after cardiac valve surgery in patients with normal thyroid function, and to identify high-risk individuals for postoperative AF among patients undergoing cardiac valve surgery.Methods:This retrospective study enrolled patients(≥18 years old)with valvular heart disease who underwent heart valve replacement or valvoplasty surgery from December 2019 to January 2023 in Beijing Anzhen Hospital. Patients with thyroid function tests exceeding the normal reference range(7.64-16.03 pmol/L) were excluded, resulting in a final cohort of 2 645 patients, including 1 597 males and 1 048 females; aged 18-83 years, with a median age of 56 (46, 64) years. Among them, 1 891 patients (71.5%) had hypertension, and 176 (6.7%) had type 2 diabetes. The patients were divided into four groups based on quartiles of FT4 levels: Group 1 (n=661) with FT4 levels of 7.64-10.33 pmol/L, Group 2 (n=661) with 10.33-11.36pmol/L, Group 3 (n=661) with 11.36-12.54 pmol/L, and Group 4(n=662) with 12.54-13.66pmol/L. The risk of postoperative AF was compared among the four groups, and logistic regression was used to adjust for relevant risk factors. The odds ratio ( OR) and 95% confidence interval( CI) for postoperative AF across different groups were analyzed. Subgroup analyses were performed based on age, gender, hypertension status, and B-type natriuretic peptide (BNP) levels to compare the association between FT4 levels and new-onset AF within different subgroups. Results:Statistically significant differences were observed among the four groups in terms of age, body mass index, hypertension, hyperlipidemia, BNP, glomerular filtration rate, triglyceride, and total cholesterol levels ( P<0.05), while no significant differences were found in other indicators( P<0.05). Using the lowest FT4 group as the baseline, a higher risk of postoperative new-onset AF was observed in groups with higher FT4 levels, with a significant trend of incremental increase in postoperative AF with rising FT4 levels. Similar trends were observed across subgroups stratified by age, gender, hypertension status, and BNP levels. The Youden index indicated a cut-off value of 11.485pmol/L for FT4. Conclusion:Among patients with normal thyroid function and valvular heart disease, preoperative higher FT4 levels are significantly associated with an increased risk of new-onset AF after cardiac valve surgery. Close monitoring for postoperative AF risk is recommended for patients with preoperative FT4 levels exceeding 11.485 pmol/L, even if the thyroid function is still within the normal.