Advancing Prognostic Prediction in Pediatric Trauma: The Role of Inflammatory Markers

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 - procalcitonin

Schlüsselwörter

Multiples Trauma - Kindersterblichkeit - Systemisches - Entzündungsreaktions syndrom - Multiples Organversagen - Procalcitonin

Publication History

Article published online:
10 December 2024

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