58 例严重脓毒血症患儿肝损伤的临床分析.

Objective To investigate the clinical characteristics and prognostic value of liver injury in children with severe sepsis. Methods Children with severe sepsis who were admitted to our hospital and had complete clinical data from November 2013 to May 2015 were enrolled as subjects. Clinical characteristics and parameters of liver function were evaluated within 24 hours after admission to the hospital. The relationship of the parameters of liver function with the level and prognosis of severe sepsis was analyzed. Continuous data of the two groups were compared using the Mann-Whiteny U test and categorical data were copared using the χ2 test. Results A total of 110 patients were enrolled as subjects. In these patients, 52.7% (58/110) had liver injury. According to the level of alanine aminotransferase (ALT), patients were divided into four groups that had ATL levels of ＜80 IU/L, 80-200 IU/L, 200-400 IU/L, and ＞400 IU/L, respectively. There were significant differences in mortality rate between the four groups (40.7%, 47.6%, 64.3%, and 81.3%; χ2=9.458, P＜0.05). Patients were divided into jaundice group and non-jaundice group based on the total bilirubin level. The jaundice group had a significantly higher mortality rate than the non-jaundice group (75.0% vs 44.2%, χ2=7.129, P＜0.01). According to the level of serum albumin, patients were divided into four groups that had levels of serum albumin of ＞35 g/L, 30-35 g/L, 25-30 g/L, and ＜25 g/L, respectively. There were significant differences in mortality rate between the four groups (35.9%, 44.1%, 59.1%, and 93.3%; χ2=15.536, P＜0.01). According to the International Normalized Ratio, patients were divided into coagulopathy group and non-coagulopathy group. The mortality rate was significantly higher in the coagulopathy group than in the non-coagulopathy group (80.8% vs 41.7%, χ2=12.147, P＜0.01). The survival group had significantly higher incidence rates of increased ALT level, jaundice, hypoproteinemia, and coagulopathy than the dead group (all P＜0.05). Conclusion The incidence of liver injury is high in children with severe sepsis. The mortality rate in patients is significantly correlated with the increase in the ALT level, jaundice, hypoproteinemia, and coagulopathy, which play an important role in the prognosis of severe sepsis. [ABSTRACT FROM AUTHOR]