Clinical significance of sCD14-ST in early diagnosis of children sepsis

Abstract

Objective To explore the clinical significance of sCD14-ST in diagnosing children sepsis and monitoring the treatment effects. Methods Case-control study. Patients were recruited by Longyan First Hospital from August 2013 to March 2015. The sCD14-ST, WBC, CRP, PCT and APACHE-Ⅱlevels were measured in 237 septic children (infectious SIRS, including 120 bacterial and 117 nonbacterial SIRS), 89 non-infectious SIRS and 156 healthy children. The changes and the correlation of the five indicators in septic children before and after treatment was compared. The diagnosis value of sCD14-ST in sepsis by the receiver operationg characteristic curves (ROC) was analyzed. Results The sCD14-ST level in septic children [643.47(596.47-690.46)ng/L] was higher than that in non-infectious SIRS [246.94(234.85-259.03)ng/L]and healthy control [151.00(142.79-159.22)ng/L](χ2=121.850, 325.663, P<0.01). The whole blood level of sCD14-ST in bacterial sepsis [606.17(542.71-669.63)ng/L]and non-bacterial sepsis [679.83(610.37-747.29)ng/L]were no significance (χ2=0.854, P=0.335), while compared with the control group, they had significant differences (χ2=326.228, P<0.01). Totally 80 blood culture samples were positive in 117 bacterial septic children, and the sCD14-ST level was not significant between Gram positive bacteria infection and [641.07(553.82-728.31)ng/L] Gram negative bacteria infection[750.00(597.10-902.89)ng/L] (χ2=1.12, P=0.29), but the sCD14-ST level in blood culture positive children was significantly higher than healthy controls (chi-square =117.46, 155.846, P<0.01). sCD14-ST, WBC, CRP, PCT, APACHE-Ⅱ score before and after treatment were all significantly decreased ( χ2=44.569, 113.337, 63.986, 100.055, 51.015, P<0.01). The sCD14-ST was significantly positively related withCRP and APACHE-Ⅱ score before treatment, but there were no correlation with WBC and PCT. The ROC-AUC of sCD14-ST in septic children was 0.901. Compared with the ROC-AUCs of WBC (0.875) and CRP (0.836), there were statistically significant different (P<0.01). The sensitivity and specificity of sCD14-ST were 85%, 90%, respectively. Conclusions The study suggested that sCD14-ST superior value to the diagnosis of sepsis in children than other parameters. It should be applied as a valuable biomarker for early diagnosis and the evaluation of severity of sepsis. (Chin J Lab Med, 2016, 39: 251-255) Key words: Sepsis; Child; Systemic inflammatory response syndrome; Antigens, differentiation; Case-control studies