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DOI: 10.1055/a-2451-6973
Advancing Prognostic Prediction in Pediatric Trauma: The Role of Inflammatory Markers
Fortschritte bei der prognostischen Vorhersage bei pädiatrischen Traumata: Die Rolle von Entzündungsmarkern
Abstract
Background This study aimed to evaluate the prognostic value of various inflammatory markers and indices derived from complete blood counts in predicting mortality among pediatric trauma patients admitted to the Pediatric Intensive Care Unit (PICU).
Patients and Methods We designed a single-center retrospective study that included 165 pediatric trauma patients in the PICU between January 2020 and June 2024.
Results Of 165 patients, 108 (69.2%) were male and the mean age of all patients was 75.16±57.14 months. The mortality rate was found to be 5.45% (9 patients). The Lactate-to-Albumin Ratio (LAR) and Procalcitonin (PCT) demonstrated strong prognostic performance with area under the curve (AUCs) of 0.807 and 0.745, respectively. Notably, LAR and PCT correlated well with mortality and the duration of invasive mechanical ventilation and PICU stay. The Systemic Immune-Inflammation Index (SIRI), Neutrophil-to-Lymphocyte Ratio (NLR), CRP-to-Albumin Ratio (CAR), and Pan-Immune-Inflammation Value (PIV) were less effective individually but showed potential when combined with other indices.
Conclusion LAR, PCT, SIRI, NLR, CAR, and PIV were associated with mortality in pediatric trauma patients, with LAR and PCT demonstrating superior predictive value. Therefore, LAR and PCT may serve as reliable standalone markers for identifying critically ill pediatric trauma patients at risk of mortality.
Zusammenfassung
Hintergrund Ziel dieser Studie war es, den prognostischen Wert verschiedener Entzündungsmarker und aus dem vollständigen Blutbild abgeleiteter Indizes zur Vorhersage der Sterblichkeit bei pädiatrischen Traumapatienten, die auf der pädiatrischen Intensivstation (PICU) aufgenommen wurden, zu bewerten.
Patienten und Methoden Wir entwarfen eine retrospektive Studie an einem einzigen Zentrum, die 165 pädiatrische Traumapatienten auf der PICU zwischen Januar 2020 und Juni 2024 einschloss.
Resultat Von den 165 Patienten waren 108 (69,2%) männlich und 48 (30,8%) weiblich, mit einem Durchschnittsalter von 75,16±57,14 Monaten. Die Sterblichkeitsrate lag bei 5,45% (9 Patienten). Das Laktat-Albumin-Verhältnis (LAR) und das Procalcitonin (PCT) zeigten eine starke prognostische Leistung mit einer Fläche unter der Kurve (AUC) von 0,807 bzw. 0,745. Insbesondere korrelierten LAR und PCT gut mit der Mortalität und der Dauer der invasiven mechanischen Beatmung und des Aufenthalts auf der Intensivstation. Der Systemic Immune-Inflammation Index (SIRI), das Neutrophilen-zu-Lymphozyten-Verhältnis (NLR), das CRP-zu-Albumin-Verhältnis (CAR) und der Pan-Immune-Inflammation Value (PIV) waren einzeln weniger aussagekräftig, zeigten jedoch Potenzial, wenn sie mit anderen Indizes kombiniert wurden.
Schlussfolgerung LAR, PCT, SIRI, NLR, CAR und PIV wurden mit der Sterblichkeit bei pädiatrischen Traumapatienten in Verbindung gebracht, wobei LAR und PCT einen höheren Vorhersagewert aufwiesen. Daher können LAR und PCT als zuverlässige eigenständige Marker für die Identifizierung kritisch kranker pädiatrischer Traumapatienten mit Sterberisiko dienen.
Keywords
multiple trauma - child mortality - systemic inflammatory response - syndrome - multiple organ failure - procalcitoninSchlüsselwörter
Multiples Trauma - Kindersterblichkeit - Systemisches - Entzündungsreaktions syndrom - Multiples Organversagen - ProcalcitoninPublikationsverlauf
Artikel online veröffentlicht:
10. Dezember 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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References
- 1 Vos T, Lim SS, Abbafati C. et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet 2020; 396: 1204-1222
- 2 Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma. Injury. 2007; 38: 1336-1345
- 3 Durak C, Sahin EG, Can YY. et al. The value of prognostic markers for pediatric trauma patients. World J Emerg Med 2023; 14: 448
- 4 Demetriades D, Murray J, Charalambides K. et al. Trauma fatalities: time and location of hospital deaths. J Am Coll Surg 2004; 198: 20-26
- 5 Kocoglu Barlas U, Akcay N, Talip M. et al. Is the prognosis of traumatic critically ill pediatric patients predictable? : A multicenter retrospective analysis. Wien Klin Wochenschr 2023; 135: 639-645
- 6 Lord JM, Midwinter MJ, Chen YF. et al. The systemic immune response to trauma: an overview of pathophysiology and treatment. Lancet 2014; 384: 1455-1465
- 7 Weber B, Lackner I, Braun CK. et al. Laboratory Markers in the Management of Pediatric Polytrauma: Current Role and Areas of Future Research. Front Pediatr 2021; 9: 622753
- 8 Moore FA, Moore EE. Evolving concepts in the pathogenesis of postinjury multiple organ failure. Surg Clin North Am 1995; 75: 257-277
- 9 Arslan G, Besci T, Özdemir G. et al. Predictive Value of PRISM-4, PIM-3, CRP, Albumin, CRP/Albumin Ratio and Lactate in Critically Ill Children. Children (Basel) 2023; 10: 1731
- 10 Özel A, Barlas UK, Yüce S. et al. Pediatric Early Warning Score (PEWS) in predicting prognosis of critical pediatric trauma patients: a retrospective study. Braz J Anesthesiol 2024; 844540
- 11 Colak M, Arda Kilinc M, Güven R. et al. Procalcitonin and blood lactate level as predictive biomarkers in pediatric multiple trauma patients' pediatric intensive care outcomes: A retrospective observational study. Medicine (Baltimore) 2023; 102: e36289
- 12 Tepas JJ, Mollitt DL, Talbert JL. et al. The pediatric trauma score as a predictor of injury severity in the injured child. J Pediatr Surg 1987; 22: 14-18
- 13 Jain S, Iverson LM. Glasgow Coma Scale. StatPearls Publishing; 2024. [1 Jul 2024]. Available from https://www.ncbi.nlm.nih.gov/books/NBK513298/
- 14 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24: 743-752
- 15 Wang R, He M, Qu F. et al. Lactate Albumin Ratio Is Associated With Mortality in Patients With Moderate to Severe Traumatic Brain Injury. Front Neurol 2022; 13: 662385
- 16 Vincent JL, Quintairos ESA, Couto L. et al. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016; 20: 257
- 17 Chen D, Bao L, Lu SQ. et al. Serum albumin and prealbumin predict the poor outcome of traumatic brain injury. PLoS One 2014; 9: e93167
- 18 AlRawahi AN, AlHinai FA, Doig CJ. et al. The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review. Crit Care 2019; 23: 390
- 19 Sakran JV, Michetti CP, Sheridan MJ. et al The utility of procalcitonin in critically ill trauma patients. J Trauma Acute Care Surg 2012; 73: 413-418 discussion 418.
- 20 Heffernan DS, Monaghan SF, Thakkar RK. et al. Failure to normalize lymphopenia following trauma is associated with increased mortality, independent of the leukocytosis pattern. Crit Care 2012; 16: R12
- 21 Mao B, Feng L, Lin D. et al. The predictive role of systemic inflammation response index in the prognosis of traumatic brain injury: A propensity score matching study. Front Neurol 2022; 13: 995925
- 22 Xu H, Wu W, Zhu Q. et al. Systemic Immune-Inflammation Index Predicts the Prognosis of Traumatic Brain Injury. World Neurosurg 2024; 183: e22-e27
- 23 Yasar B, Ozbilgehan P, Sen M. et al. Influence of systemic inflammatory indices on hospital stay and dialysis post-earthquake: A clinical study. PLoS One 2024; 19: e0299737
- 24 Brunengraber LN, Robinson AV, Chwals WJ. Relationship of serum C-reactive protein and blood glucose levels with injury severity and patient morbidity in a pediatric trauma population. J Pediatr Surg 2009; 44: 992-996
- 25 Lu X, Liu WC, Qin Y. et al. C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients. Curr Med Sci 2023; 43: 360-366