Vasoactive Peptides In The Early Stage Of Sepsis Diagnosis And Condition To Judge The Significance

Objectives: To evaluate the early diagnostic and prognostic values of Procalcitonin (PCT), Proadrenomedullin (Pro-ADM), Proendothelin (Pro-ET1), Provasopressin (Pro-AVP) and Pro-atrial natriuretic peptide(Pro-ANP) in children with sepsis.Methods: According to the definitions of sepsis and organ dysfunction in pediatrics, patients who were admitted to the intensive care unit of the Children's Hospital of Fudan University from August 2007 to March 2008 were classified into the non-sepsis group and the sepsis one. The levels of PCT, Pro-ADM, Pro-ET1, Pro-AVP and Pro-ANP were determined within 24 hours. We developed a new sandwich immunoassay for PCT, Pro-ADM, Pro-ET1, Pro-AVP, Pro-ANP. The PCIS score was progressed at the same time. Statistical analysis of the data was performed using the SPSS 13.0 software.Results: Fifty-three patients of the sepsis group and forty-four patients in the non-sepsis one were included.1. PCT: The levels of PCT in the sepsis group were significantly higher than that in the non-sepsis one, and the PCT levels of the surviving patients were significantly higher than that of the non-surviving sepsis ones. In the sepsis children a highly significantly negative correlation was found between serum PCT levels and PCIS score.In this group who were less than 3 years old, a highly significantly negative correlation was found between serum PCT levels and PCIS score. While in the sepsis ones who were older than 3 years old, no correlation was found.2. Pro-ADM: The levels of Pro-ADM in the sepsis group were significantly higher than that in the non-sepsis one. The Pro-ADM levels of the surviving patients were significantly higher than that of the non-surviving sepsis patients. In the sepsis group, a highly significant negative correlation was found between serum Pro-ADM levels and PCIS score. We also found a significantly positive correlation between serum PCT concentration and Pro-ADM concentration.3. Pro-ET1: The levels of Pro-ET1 in the sepsis group were significantly higher than that in the non-sepsis one. However, the Pro-ET1 levels in the surviving sepsis patients were found no statistical difference while compared with that in the non-surviving sepsis ones. In the sepsis group a highly significantly negative correlation was found between serum Pro-ET1 levels and PCIS score, and a significantly positive correlation was found between serum Pro-ET1 levels and PCT levels. In this group who were less than 3 years old, a highly significantly negative correlation was found between serum Pro-ET1 levels and PCIS score, while a highly significantly positive correlation was found between serum Pro-ET1 levels and PCT levels. While in sepsis patients more than 3 years old, there was no correlation found.4. Pro-AVP: The levels of Pro-AVP in the sepsis group were significantly higher than that in the non-sepsis one, and the Pro-AVP levels in surviving patients were significantly higher than that in non-surviving sepsis ones. In the sepsis children, a significantly negative correlation was found between serum Pro-ET1 levels and PCIS score, and a significantly positive correlation was found between serum Pro-ET1 levels and PCT levels. In this group less than 3 years old, a significantly negative correlation was found between serum Pro-ET1 levels and PCIS score, and a significantly positive correlation was found between serum Pro-ET1 levels and PCT levels. While in the sepsis patients who were older than 3 years old, there was no correlation found.5. Pro-ANP: The levels of Pro-ANP in the sepsis group were significantly higher than that in the non-sepsis one. However, the Pro-ANP levels in surviving sepsis patients had not statistical difference while compared with that in non-surviving sepsis ones. In the sepsis patients, no correlation was found either between serum Pro-ANP levels and PCIS score or between serum Pro-ANP levels and PCT levels .In this group who were less than 3 years old, no correlation was found either between serum Pro-ANP levels and PCIS score or between serum Pro-ANP levels and PCT levels. In the sepsis children who were older than 3 years old, a significantly negative correlation was found between serum Pro-ANP levels and PCIS score, while a significantly positive correlation was found between serum Pro-ANP levels and PCT levels. We also found the Pro-ANP levels in the sepsis group less than 3 years old were significantly higher than that in those less than 3 years old.Conclusion:1. The levels of PCT, Pro-ADM, Pro-ET1, Pro-AVP and Pro-ANP in the sepsis group were higher than that in the non-sepsis one.2. The PCT,Pro-ADM and Pro-AVP levels of the surviving children were significantly higher than those in the non-surviving sepsis ones. However the Pro-ET1,Pro-ANP levels were not found statistically difference between two groups.3. In sepsis patients, a significantly negative correlation was found between serum PCT,Pro-ADM,Pro-ET1,Pro-AVP levels and PCIS score. While there was no correlation between Pro-ANP levels and PCIS score. 4. In sepsis patients, a significantly negative correlation was found between serum Pro-ADM,Pro-ET1,Pro-AVPand serum PCT levels. But we found no correlation between serum Pro-ANP levels and serum PCT levels.5. ,Pro-ADM, Pro-ET1, Pro-AVP, Pro-ANP were the useful parameters to diagnose sepsis in children. PCT, Pro-ADM, Pro-AVP correlate with infection severity. While the correlation between Pro-ET1, Pro-ANP levels and infection severity needs further study.