Clinical Significance Of Pancreatic Stone Protein/regenerating Protein In Children With Sepsis And Effects Of Pancreatic Damage

Objectives To explore clinical value of pancreatic stone protein /regenerating protein(PSP/reg) in diagnosing sepsis and severity, predicting organ failure and prognosis, explore effects of pancreatic damage.Methods In this prospective study from September 2013 to September 2014, we collected clinical data and blood samples(at 1st,3rd, 7th day after staying in PICU) to detect PSP/reg levels in the pediatric intensive care unit of Hunan Children’s Hospital.Chi-square test, nonparametric rank sum test, Spearman correlation and other statistical methods were used to statistical analysis.Results1、PSP/reg had positive correlation with PCT(r=0.376,P=0.000),had weaker correlations with WBC and CRP(WBC:r=0.154,P=0.015;CRP: r=0.129,P=0.041).2、With sepsis was aggravating, PSP/reg levels tended to rise at 1st, 3rd, 7th day( H value were 97.408, 36.814, 22.366, P=0.000); The dynamic change of PSP/reg at 1st, 3rd, 7th day: there were no statistical differences in non-sepsis group(H=1.294,P=0.524); the first day PSP/reg was obviously higher than 3rd and 7th day, but there were no statistical differences between 3rd and 7th day in sepsis group; there were no statistical differences before 3 days after staying in PICU, 7th day had obviously declined in severe sepsis group.3、The more organs failure, the higher PSP/reg levels at 1st, 3rd, 7th day( H value were 65.924,29.481,21.977, P =0.000); The dynamic change of PSP/reg at 1st, 3rd, 7th day:there were declined tendencies in 0-1 and 2-3 organs failure goups(H values were 22.728,8.509,P values were 0.000,0.014);there were no statistical differences in more than 3 organs failure group(H=1.970,P=0.373).4、Non-survival group had higher PSP/reg levels than survival group at 1st, 3rd, 7th day(Z values were-6.085,-5.431,-3.818,P=0.000). The dynamic change of PSP/reg at 1st, 3rd, 7th day: survival group gradually declined(H=22.917,P=0.000); median value of PSP/reg gradually increased in non-survival group, but no statistical differences(H=4.081, P=0.130).5、PSP/reg had positive correlation with serum lipase and amylase(r values were 0.349,0.584,P=0.000), had no significant correlation with blood glucose, C peptide and insulin(P>0.05).Regardless of normal or high pancreatic enzyme, PSP/reg and PCT could be used to diagnose sepsis and pridict severity(AUC>0.7);compared with normal pancreatic enzyme group,value of PSP/reg and PCT in predicting death reduced, but AUC of PSP / reg and PCT were no statistical differences(Z=-1.280, P=0.201) in high pancreatic enzyme group.6、The first day PSP/reg levels in normal and high pancreatic enzyme groups : there were no statistical differences in children with non-sepsis(Z=-1.156,P=0.248), PSP/reg levels increased with pancreatic enzyme in children with sepsis and severe sepsis(Z values were-5.395,-3.934, P=0.000);PSP/reg levels increased with pancreatic enzyme in children with 0-1 and 2-3 organs failure(Z values were-5.024,-5.379;P=0.000),there were no statistical differences in children with more than three organs failure(Z=-1.20,P=0.230). PSP/reg levels increased with pancreatic enzyme in survival children(Z=-8.051,P= 0.000), there were no statistical differences in non-survival children(Z=-1.625,P=0.104).Conclusion1、PSP/reg had positive correlation with PCT,had weaker positive correlations with WBC and CRP.2、PSP/reg could be used in risk stratification, assessing organ failure and prognosis.3、Dynamic monitoring PSP / reg was helpful to evaluate severity and prognosis.4、PSP/reg was closely associated with pancreatic exocrine function; the value of PSP / reg to assess clinical conditions reduced in sepsis with pancreatic damage.