Clinical characteristics of children with urosepsis

doi:10.3877/cma.j.issn.1673-5250.2019.03.009

Objective

To discuss clinical characteristics of children with urosepsis.

Methods

Between January 2017 and June 2018, a total of 51 children were admitted as study group with the diagnosis of urosepsis. And another 102 children with non-urosepsis were selected into control group through random extraction function of Microsoft Excel 2016. The medical records of demographic data, laboratory tests, and prognosis were collected. Independent-samples t test was performed on platelet count (PLT), fibrinogen (Fib), and erythrocyte sedimentation rate (ESR). White blood cell (WBC), hemoglobin (Hb), alanine transferase (ALT), aspartate aminotransferase (AST), albumin, total bilirubin (TB), lactate dehydrogenase (LDH), creatinine, blood urea nitrogen (BUN), serum Na⁺ , serum K⁺ , serum Ca²⁺ , serum Cl^-, glucose, D-dimer (DDI), fibrinogen degradation (FDP), N-terminal pro-brain natriuretic peptide (NTBNP), troponin I (cTnI), pH value, and lactic acid were compared by Mann-Whitney U rank sum test. The chi-square test or continuity correction were used to perform statistical analysis on the ratios of gender ratio, pediatric intensive care unit (PICU) occupancy rate, and mortality. This study was in line with the World Medical Association Declaration of Helsinki revised in 2013. There was no significant difference in gender composition ratio between two groups (χ²=1.593, P=0.207).

Results

①The median age of study group was 6-month old (4-12 months old), which was younger than that of control group [10-month old (5-24 months old)] (Z=-2.660, P=0.008). ② The levels of WBC and CRP in study group were 17.4×10⁹/L [(11.8-26.6)×10⁹/L] and 120 mg/L (87-160 mg/L), which were higher than 12.0×10⁹/L [(5.0-17.6)×10⁹/L] and 48 mg/L (20-135 mg/L) in control group. The differences between two groups were statistically significant (Z=-4.145, -4.465; P all<0.001). The proportion of WBC>15×10⁹/L and CRP>40 mg/L in study group were 62.7% (32/51) and 90.2%(46/51), which were higher than those of control group 38.2%(39/102) and 55.9%(57/102), and the differences between two groups were statistically significant (χ²=8.212, 18.197; P=0.004, <0.001). ③ The values of PLT, Ca²⁺ , Fib and pH value in study group were (344.1±148.7)×10⁹/L, 2.36 mmol/L (2.29-2.49 mmol/L), (492.0±185.1) mg/dL and 7.4 (7.4-7.5), which were higher than (271.2±147.5)×10⁹/L, 2.21 mmol/L (0.08-2.39 mmol/L), (346.0±165.8) mg/dL and 7.4(7.3-7.4) of control group, and the differences between two groups were statistically significant (t=-2.871, P=0.005; Z=-4.002, P=0.992; t=-3.639, P<0.001; Z=-2.108, P=0.035). While the levels of AST, LDH, DDI and cTnI of study group were 35.0 U/L (25.8-44.2 U/L), 534.5 U/L (471.5-649.5 U/L), 1.1 mg/L (0.5-2.2 mg/L), 0.01 μg/L (0.01-0.01 μg/L), which were lower than 46.5 U/L (46.0-87.2 U/L), 673.0 U/L (535.0-1 106.0 U/L), 2.5 mg/L(1.2-4.0 mg/L) and 0.01 μg/L (0.01-0.04 μg/L) of control group, and the differences between two groups were statistically significant (Z=-4.130, 3.851, -2.175, -3.716; P all<0.05). ④The proportion of children required respiratory support, partial pressure of oxygen in artery(PaO₂)/fraction of inspired oxygen(FiO₂)<300 mmHg, activated partial thromboplastin time(APTT) prolongation >10 s, PLT<150×10⁹/L, elevated in cTnI, AST>100 U/L, neurological symptoms, Ca²⁺ <2.1 mmol/L in study group were 11.8% (6/51), 3.9% (2/51), 8.0% (2/25), 7.8% (4/51), 3.7% (1/27), 6.0% (3/50), 29.4% (15/51), 6.1% (3/49), lower than 47.1%(48/102), 27.5%(28/102), 35.3% (24/68), 20.6% (21/102), 34.4% (22/64), 25.5% (26/102), 61.8% (63/102) and 27.6%(27/98) of control group, and the differences were statistically significant (χ²=18.545, 11.941, 6.761, 4.040, 9.458, 8.255, 14.241, 9.235; P all<0.05). ⑤ Among 51 children in study group, 49 children (96.1%, 49/51) showed increased levels of leucocytes and pus cells according to urine routine examination results, another 2 children showed normalities in urine and urine culture but abdominal CT examination results showed renal abscess. ⑥ The PICU transfer rate and mortality of study group were significantly lower than those of control group, and the differences between two groups were statistically significant (χ²=17.480, 6.142; P all<0.05).

Conclusions

Children with urosepsis is more likely to have higher WBC and CRP level, lower organ function rate and better prognosis. For children with sepsis accompanied by high level of inflammatory maker and lower organ dysfunction rate, it is of great significance to carry out early urinalysis, urine culture and have ultrasound or CT of urinary system.

Key words: Sepsis, Urinary tract infections, Inflammasomes, Bacterial infections, Procalcitonin, Diagnosis, Prognosis, Child

表1 2组患儿炎症指标比较

组别	例数	WBC[×10⁹/L，M(P₂₅～P₇₅)]	中性粒细胞百分比(%，±s)	CRP[mg/L，M(P₂₅～P₇₅)]	PCT[ng/mL，M(P₂₅～P₇₅)]
研究组	51	17.4(11.8～26.6)	61.2±15.8	120(87～160)	6.8(2.0～22.1)^a
对照组	102	12.0(5.0～17.6)	58.7±20.5	48(20～135)	4.2(0.6～17.1)^a
检验值	?	Z＝－4.145	t＝－0.806	Z＝－4.465	Z＝－1.449
P值	?	<0.001	0.422	<0.001	0.147
组别	例数	WBC>15×10⁹/L[例数(%)]	中性粒细胞百分比>80%[例数(%)]	CRP>40 mg/L[例数(%)]	PCT>0.5 ng/mL[例数(%)]
研究组	51	32(62.7)	4(7.8)	46(90.2)	34(94.4)^a
对照组	102	39(38.2)	19(18.6)	57(55.9)	64(84.2)^a
检验值	?	χ²＝8.212	χ²＝3.096	χ²＝18.197	χ²＝1.497
P值	?	0.004	0.078	<0.001	0.221

表1 2组患儿炎症指标比较

组别	例数	WBC[×10⁹/L，M(P₂₅～P₇₅)]	中性粒细胞百分比(%，±s)	CRP[mg/L，M(P₂₅～P₇₅)]	PCT[ng/mL，M(P₂₅～P₇₅)]
研究组	51	17.4(11.8～26.6)	61.2±15.8	120(87～160)	6.8(2.0～22.1)^a
对照组	102	12.0(5.0～17.6)	58.7±20.5	48(20～135)	4.2(0.6～17.1)^a
检验值	?	Z＝－4.145	t＝－0.806	Z＝－4.465	Z＝－1.449
P值	?	<0.001	0.422	<0.001	0.147
组别	例数	WBC>15×10⁹/L[例数(%)]	中性粒细胞百分比>80%[例数(%)]	CRP>40 mg/L[例数(%)]	PCT>0.5 ng/mL[例数(%)]
研究组	51	32(62.7)	4(7.8)	46(90.2)	34(94.4)^a
对照组	102	39(38.2)	19(18.6)	57(55.9)	64(84.2)^a
检验值	?	χ²＝8.212	χ²＝3.096	χ²＝18.197	χ²＝1.497
P值	?	0.004	0.078	<0.001	0.221

表2 2组患儿降钙素原不同升高程度比较

组别	例数	PCT值升高程度[例数(%)]
组别	例数	0～5 ng/mL	5～10 ng/mL	10～15 ng/mL	15～20 ng/mL	>20 ng/mL
研究组	36	13(36.1)	8(22.2)	3(8.3)	0(0)	12(33.3)
对照组	76	42(55.3)	10(13.2)	3(3.9)	5(6.6)	16(21.1)
χ²值	?	7.614
P值	?	0.087

表2 2组患儿降钙素原不同升高程度比较

组别	例数	PCT值升高程度[例数(%)]
组别	例数	0～5 ng/mL	5～10 ng/mL	10～15 ng/mL	15～20 ng/mL	>20 ng/mL
研究组	36	13(36.1)	8(22.2)	3(8.3)	0(0)	12(33.3)
对照组	76	42(55.3)	10(13.2)	3(3.9)	5(6.6)	16(21.1)
χ²值	?	7.614
P值	?	0.087

表3 2组患儿实验室检查结果比较

组别	例数	肝功能
组别	例数	ALT [U/L，M(P₂₅～P₇₅)]	AST [ U/L，M(P₂₅～P₇₅)]	白蛋白[g/L，M(P₂₅～P₇₅)]	TB [μmol/L，M(P₂₅～P₇₅)]	LDH [U/L，M(P₂₅～P₇₅)]
研究组	51	34.0(27.0～44.0)	35.0(25.8～44.2)	37.1(32.2～39.1)	4.1(2.1～7.3)	534.5(471.5～649.5)
对照组	102	36.5(25.0～54.2)	46.5(46.0～87.2)	36.9(31.2～40.9)	4.6(2.3～9.4)	673.0(535.0～1 106.0)
检验值	?	Z＝－1.104	Z＝－4.130	Z＝－0.118	Z＝－0.635	Z＝－3.851
P值	?	0.269	<0.001	0.906	0.525	<0.001
组别	例数	血常规检查		肾功能
组别	例数	Hb(g/L，±s)	PLT(×10⁹/L，±s)	肌酐[μmol/L，M(P₂₅～P₇₅)]	BUN [mmol/L，M(P₂₅～P₇₅)])
研究组	51	101.0(89.0～109.0)	344.1±148.7	31.0(26.0～36.5)	3.2(2.2～4.2)
对照组	102	104.5(88.5～115.0)	271.2±147.5	31.5(25.0～40.0)	2.8(2.3～4.3)
检验值	?	Z＝0.681	t＝－2.871	Z＝－0.370	Z＝－0.209
P值	?	0.497	0.005	0.711	0.835
组别	例数	血糖[mmol/L，M(P₂₅～P₇₅)]	电解质检查
组别	例数	血糖[mmol/L，M(P₂₅～P₇₅)]	血Na^＋ [mmol/L，M(P₂₅～P₇₅)]	血K^＋[mmol/L，M(P₂₅～P₇₅)]	血Cl^－[mmol/L，M(P₂₅～P₇₅)]	血Ca^2＋[mmol/L，M(P₂₅～P₇₅)]
研究组	51	5.5(4.9～6.1)	135.2(133.8～137.8)	4.2(3.7～4.6)	102.9(100.2～105.0)	2.3(2.3～2.5)
对照组	102	5.6(4.9～6.4)	136.0(132.3～138.0)	4.2(3.7～4.5)	102.6(97.9～107.0)	2.2(0.1～2.4)
检验值	?	Z＝－0.601	Z＝－0.266	Z＝－0.452	Z＝－0.010	Z＝－4.002
P值	?	0.548	0.790	0.652	0.992	<0.001
组别	例数	ESR(mm/h，±s)	凝血功能
组别	例数	ESR(mm/h，±s)	Fib(mg/dL，±s)	DDI [mg/L，M(P₂₅～P₇₅)]	FDP [μg/mL，M(P₂₅～P₇₅)]
研究组	51	48.8±36.4	492.0±185.1	1.1(0.5～2.2)	5.7(3.6～11.6)
对照组	102	42.2±30.0	346.0±165.8	2.5(1.2～4.0)	9.2(4.5～13.7)
检验值	?	t＝－0.608	t＝－3.639	Z＝－2.175	Z＝－0.931
P值	?	0.547	<0.001	0.030	0.352
组别	例数	NTBNP [pg/mL，M(P₂₅～P₇₅)]	cTnI [μg/L，M(P₂₅～P₇₅)]	pH值[M(P₂₅～P₇₅)]	乳酸[mmol/L，M(P₂₅～P₇₅)]
研究组	51	1 120.0(373.0～3 180.0)	0.01(0.01～0.01)	7.4(7.4～7.5)	1.8(1.3～2.4)
对照组	102	2 120.0(377.0～7 690.0)	0.01(0.01～0.04)	7.4(7.3～7.4)	1.8(1.1～2.6)
检验值	?	Z＝－1.133	Z＝－3.716	Z＝－2.108	Z＝－0.194
P值	?	0.257	<0.001	0.035	0.846

表3 2组患儿实验室检查结果比较

组别	例数	肝功能
组别	例数	ALT [U/L，M(P₂₅～P₇₅)]	AST [ U/L，M(P₂₅～P₇₅)]	白蛋白[g/L，M(P₂₅～P₇₅)]	TB [μmol/L，M(P₂₅～P₇₅)]	LDH [U/L，M(P₂₅～P₇₅)]
研究组	51	34.0(27.0～44.0)	35.0(25.8～44.2)	37.1(32.2～39.1)	4.1(2.1～7.3)	534.5(471.5～649.5)
对照组	102	36.5(25.0～54.2)	46.5(46.0～87.2)	36.9(31.2～40.9)	4.6(2.3～9.4)	673.0(535.0～1 106.0)
检验值	?	Z＝－1.104	Z＝－4.130	Z＝－0.118	Z＝－0.635	Z＝－3.851
P值	?	0.269	<0.001	0.906	0.525	<0.001
组别	例数	血常规检查		肾功能
组别	例数	Hb(g/L，±s)	PLT(×10⁹/L，±s)	肌酐[μmol/L，M(P₂₅～P₇₅)]	BUN [mmol/L，M(P₂₅～P₇₅)])
研究组	51	101.0(89.0～109.0)	344.1±148.7	31.0(26.0～36.5)	3.2(2.2～4.2)
对照组	102	104.5(88.5～115.0)	271.2±147.5	31.5(25.0～40.0)	2.8(2.3～4.3)
检验值	?	Z＝0.681	t＝－2.871	Z＝－0.370	Z＝－0.209
P值	?	0.497	0.005	0.711	0.835
组别	例数	血糖[mmol/L，M(P₂₅～P₇₅)]	电解质检查
组别	例数	血糖[mmol/L，M(P₂₅～P₇₅)]	血Na^＋ [mmol/L，M(P₂₅～P₇₅)]	血K^＋[mmol/L，M(P₂₅～P₇₅)]	血Cl^－[mmol/L，M(P₂₅～P₇₅)]	血Ca^2＋[mmol/L，M(P₂₅～P₇₅)]
研究组	51	5.5(4.9～6.1)	135.2(133.8～137.8)	4.2(3.7～4.6)	102.9(100.2～105.0)	2.3(2.3～2.5)
对照组	102	5.6(4.9～6.4)	136.0(132.3～138.0)	4.2(3.7～4.5)	102.6(97.9～107.0)	2.2(0.1～2.4)
检验值	?	Z＝－0.601	Z＝－0.266	Z＝－0.452	Z＝－0.010	Z＝－4.002
P值	?	0.548	0.790	0.652	0.992	<0.001
组别	例数	ESR(mm/h，±s)	凝血功能
组别	例数	ESR(mm/h，±s)	Fib(mg/dL，±s)	DDI [mg/L，M(P₂₅～P₇₅)]	FDP [μg/mL，M(P₂₅～P₇₅)]
研究组	51	48.8±36.4	492.0±185.1	1.1(0.5～2.2)	5.7(3.6～11.6)
对照组	102	42.2±30.0	346.0±165.8	2.5(1.2～4.0)	9.2(4.5～13.7)
检验值	?	t＝－0.608	t＝－3.639	Z＝－2.175	Z＝－0.931
P值	?	0.547	<0.001	0.030	0.352
组别	例数	NTBNP [pg/mL，M(P₂₅～P₇₅)]	cTnI [μg/L，M(P₂₅～P₇₅)]	pH值[M(P₂₅～P₇₅)]	乳酸[mmol/L，M(P₂₅～P₇₅)]
研究组	51	1 120.0(373.0～3 180.0)	0.01(0.01～0.01)	7.4(7.4～7.5)	1.8(1.3～2.4)
对照组	102	2 120.0(377.0～7 690.0)	0.01(0.01～0.04)	7.4(7.3～7.4)	1.8(1.1～2.6)
检验值	?	Z＝－1.133	Z＝－3.716	Z＝－2.108	Z＝－0.194
P值	?	0.257	<0.001	0.035	0.846

表4 2组判断患儿脏器功能损害情况指标的发生率比较[%(n/n′)]

组别	例数	呼吸系统		凝血功能
组别	例数	呼吸支持治疗	PaO₂/FiO₂<300 mmHg	PT延长>3 s	APTT延长>10 s	Fib<200 mg/L	INR>1.5	PLT<150×10⁹/L	PLT<100×10⁹/L
研究组	51	11.8(6/51)	3.9(2/51)	4.0(1/25)	8.0(2/25)	12.0(3/25)	4.0(1/25)	7.8(4/51)	3.9(2/51)
对照组	102	47.1(48/102)	27.5(28/102)	19.1(13/68)	35.3(24/68)	22.4(15/67)	13.2(9/68)	20.6(21/102)	13.7(14/102)
χ²值	?	18.545	11.941	2.192 ^a	6.761	0.676 ^a	0.805 ^a	4.040	3.490
P值	?	<0.001	0.001	0.139	0.009	0.441	0.370	0.044	0.062
组别	例数	心血管系统				消化系统
组别	例数	低血压或者低灌注表现	乳酸>2.5 mmol/L	cTnI升高	NTBNP>450 pg/mL	肠鸣音减弱或者消失	AST>100 U/L	ALT>80 U/L	TB>70 μmol/L
研究组	51	9.8(5/51)	14.3(2/14)	3.7(1/27)	63.6(7/11)	2.0(1/51)	6.0(3/50)	6.0(3/50)	2.0(1/50)
对照组	102	13.7(14/102)	25.0(15/60)	34.4(22/64)	74.5(38/51)	4.9(5/102)	25.5(26/102)	13.7(14/102)	4.9(5/102)
χ²值	?	0.481	0.255 ^a	9.458	0.130	—0.195 ^a	8.255	2.016	－0.176 ^a
P值	?	0.448	0.613	0.002	0.718	0.659	0.004	0.156	0.664
组别	例数	神经系统症状^b	泌尿系统			电解质
组别	例数	神经系统症状^b	BUN>82 mmol/L	肌酐>10.7 μmol/L	少尿或者无尿	血清Na^＋<135 mmol/L	血清K^＋<3.5 mmol/L	血K^＋>5.5 mmol/L	血清Ca^2＋<2.1 mmol/L
研究组	51	29.4(15/51)	4.1(2/49)	4.1(2/49)	3.9(2/51)	38.8(19/49)	18.4(9/49)	4.1(2/49)	6.1(3/49)
对照组	102	61.8(63/102)	4.9(5/102)	4.9(5/102)	2.9(3/102)	47.1(48/102)	20.6(21/102)	4.9(5/102)	27.6(27/98)
χ²值	?	14.241	0.000 ^a	0.000 ^a	0.000 ^a	0.615	0.103	0.000 ^a	9.235
P值	?	<0.001	1.000	1.000	1.000	0.443	0.749	1.000	0.002

表4 2组判断患儿脏器功能损害情况指标的发生率比较[%(n/n′)]

组别	例数	呼吸系统		凝血功能
组别	例数	呼吸支持治疗	PaO₂/FiO₂<300 mmHg	PT延长>3 s	APTT延长>10 s	Fib<200 mg/L	INR>1.5	PLT<150×10⁹/L	PLT<100×10⁹/L
研究组	51	11.8(6/51)	3.9(2/51)	4.0(1/25)	8.0(2/25)	12.0(3/25)	4.0(1/25)	7.8(4/51)	3.9(2/51)
对照组	102	47.1(48/102)	27.5(28/102)	19.1(13/68)	35.3(24/68)	22.4(15/67)	13.2(9/68)	20.6(21/102)	13.7(14/102)
χ²值	?	18.545	11.941	2.192 ^a	6.761	0.676 ^a	0.805 ^a	4.040	3.490
P值	?	<0.001	0.001	0.139	0.009	0.441	0.370	0.044	0.062
组别	例数	心血管系统				消化系统
组别	例数	低血压或者低灌注表现	乳酸>2.5 mmol/L	cTnI升高	NTBNP>450 pg/mL	肠鸣音减弱或者消失	AST>100 U/L	ALT>80 U/L	TB>70 μmol/L
研究组	51	9.8(5/51)	14.3(2/14)	3.7(1/27)	63.6(7/11)	2.0(1/51)	6.0(3/50)	6.0(3/50)	2.0(1/50)
对照组	102	13.7(14/102)	25.0(15/60)	34.4(22/64)	74.5(38/51)	4.9(5/102)	25.5(26/102)	13.7(14/102)	4.9(5/102)
χ²值	?	0.481	0.255 ^a	9.458	0.130	—0.195 ^a	8.255	2.016	－0.176 ^a
P值	?	0.448	0.613	0.002	0.718	0.659	0.004	0.156	0.664
组别	例数	神经系统症状^b	泌尿系统			电解质
组别	例数	神经系统症状^b	BUN>82 mmol/L	肌酐>10.7 μmol/L	少尿或者无尿	血清Na^＋<135 mmol/L	血清K^＋<3.5 mmol/L	血K^＋>5.5 mmol/L	血清Ca^2＋<2.1 mmol/L
研究组	51	29.4(15/51)	4.1(2/49)	4.1(2/49)	3.9(2/51)	38.8(19/49)	18.4(9/49)	4.1(2/49)	6.1(3/49)
对照组	102	61.8(63/102)	4.9(5/102)	4.9(5/102)	2.9(3/102)	47.1(48/102)	20.6(21/102)	4.9(5/102)	27.6(27/98)
χ²值	?	14.241	0.000 ^a	0.000 ^a	0.000 ^a	0.615	0.103	0.000 ^a	9.235
P值	?	<0.001	1.000	1.000	1.000	0.443	0.749	1.000	0.002

表5 2组患儿PICU转入率和病死率比较[例数(%)]

组别	例数	转入PICU	死亡
研究组	51	9(17.6)	0(0)
对照组	102	54(52.9)	14(13.7)
χ²值	?	17.480	6.142
P值	?	<0.001	0.013

表5 2组患儿PICU转入率和病死率比较[例数(%)]

组别	例数	转入PICU	死亡
研究组	51	9(17.6)	0(0)
对照组	102	54(52.9)	14(13.7)
χ²值	?	17.480	6.142
P值	?	<0.001	0.013

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