Retrospective Analysis Of Clinical Characteristics In Children With Urosepsis From A Single Center

Objective:Though Urinary tract infection(UTI)is common in children and urosepsis is a systemic infectious disease caused by UTI,the clinical research on urosepsis in children is limited.Through the retrospective analysis of the clinical data of children with urosepsis from a single center,this essay aims to explore the clinical characteristics of children with urosepsis,and to analyze the risk factors of severe urosepsis.To improve the clinical understanding of urogenic sepsis in children and provide a basis for early identification of severe urosepsis,and to avoid poor prognosis such as chronic kidney disease.Methods:The clinical data of children hospitalized with urosepsis in the Department of Pediatrics of the First Affiliated Hospital of Xiamen University from January 2017 to December 2020 were statistically analyzed.According to the severity of patients’ symptoms,patients were divided into groups in different experiments: patients who met the diagnostic criteria of sepsis or severe sepsis or septic shock is severe urosepsis;those who met the diagnostic criteria of SIRS is mild urosepsis.The contents of the study are as follows:(1)Clinical analysis of children with single-center urosepsis,(2)multivariate logistics analysis of severe urosepsis Results:1.Clinical analysis of children with single-center urosepsis.A total of 125 children with urosepsis were included in this study,including 3 cases(2.4%)of septic shock,38 cases(30.4%)of sepsis and 84 cases(67.2%)of SIRS patients.Most of the age distribution was 1-12 months old(65%);the gender was mostly male(54.4%);sepsis related encephalopathy(SAE)occurred in 7.2% of the children;vesicoureteral reflux was the most common urinary system lesion in urosepsis;The most common pathogenic bacteria in urine and blood of children with urogenic sepsis are Escherichia coli,the drug resistance rate of urine culture was higher than that of common urinary tract infection,and the ESBLs production rate was higher.2.Multivariate logistics analysis of severe urosepsis.(1)The white blood cell count,neutrophil count,lymphocyte count,red blood cell count,hemoglobin,HCT,platelet count,NK cell ratio,albumin and total GFR in the severe group were significantly lower than those in the mild group(P<0.05).The mean platelet volume,the ratio of platelet count to lymphocyte count,INR,PT,APTT and D-dimer,PCT,alanine aminotransferase,total bilirubin,glutamyltransferase and urea in severe group were significantly higher than those in mild group(P<0.05).(2)A multivariate logistics regression model was established.It was found that PLR(OR=1.022,95%CI 1.007-1.037,P=0.003),MPV(OR=3.698,95%CI 1.395-9.805,P=0.009)and NK cell ratio(OR=0.775,95%CI 0.653-0.919,P=0.004)were independent risk factors for severe uremic sepsis,and the combined detection was the best.The regression equation is logit(P)=-14.5460.022 × PLR+1.308 × MPV-0.255 ×NK%,.The AUC of the ROC of the model is 0.867,the sensitivity is 65.5%,and the specificity is 96.4%.Conclusion:1.Clinical analysis of children with single-center urosepsis.(1)Urosepsis is one of the causes of sepsis in children,mostly occurs in children less than one year old and male children.About 1 / 3 of the children with severe sepsis.The most common urinary tract malformation is vesicoureteral reflux.(2)The most common pathogenic bacteria of urosepsis is Escherichia coli in both blood and urine cultures.The drug resistance rate of urinary Escherichia coli in children with urogenic sepsis is higher than that in children with common urinary tract infection.2.multivariate logistics analysis of severe urosepsis.The logistics regression model of severe urosepsis was constructed.When the predictive probability was ≥ 0.68,it was judged to be severe urosepsis,or it was mild.