Objective To investigate changes in complement component 3 (C3) levels in children with sepsis and its correlation with the severity of sepsis and to explore the significance of C3 in predicting mortality in children with sepsis. Methods A retrospective analysis was conducted on 529 children with sepsis who were admitted to the Pediatric Intensive Care Unit in Hunan Children's Hospital between November 2019 and September 2021. The children were categorized into two groups based on their prognosis at day 28 after sepsis diagnosis: the survival group (n=471) and the death group (n=58). Additionally, the children were divided into normal C3 group (n=273) and reduced C3 group (n=256) based on the median C3 level (0.77 g/L) within 24 hours of admission. Clinical data and laboratory markers were compared between the groups, and assess the predictive value of C3 levels in relation to sepsis-related mortality. Results The death group exhibited significantly lower C3 levels compared to the survival group (P<0.05). Multivariate logistic regression analysis revealed that higher pediatric Sequential Organ Failure Assessment (p-SOFA) scores and lower C3 levels were closely associated with sepsis-related mortality (P<0.05). The receiver operating characteristic curve (ROC) analysis demonstrated that combination of p-SOFA scores and C3 levels yielded an area under the ROC curve of 0.852, which was higher than that of each indicator alone (P<0.05). Conclusions C3 can serve as an indicator to assess the severity and prognosis of sepsis in children. The combination of p-SOFA scores and C3 levels holds good predictive value for mortality in children with sepsis.
PENG Zhi-Hui, YAN Hai-Peng, LU Xiu-Lan, ZHANG Xin-Ping, HUANG Jiao-Tian, XIAO Zheng-Hui.
Value of complement component 3 in predicting the prognosis of children with sepsis[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(9): 941-946 https://doi.org/10.7499/j.issn.1008-8830.2304041
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参考文献
1 Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 801-810. PMID: 26903338. PMCID: PMC4968574. DOI: 10.1001/jama.2016.0287. 2 Mithal LB, Arshad M, Swigart LR, et al. Mechanisms and modulation of sepsis-induced immune dysfunction in children[J]. Pediatr Res, 2022, 91(2): 447-453. PMID: 34952937. PMCID: PMC9752201. DOI: 10.1038/s41390-021-01879-8. 3 van der Poll T, Shankar-Hari M, Wiersinga WJ. The immunology of sepsis[J]. Immunity, 2021, 54(11): 2450-2464. PMID: 34758337. DOI: 10.1016/j.immuni.2021.10.012. 4 孙杭, 张宪伟, 潘伟. 补体消耗与脓毒症患儿病情严重程度的相关性[J]. 中华实用儿科临床杂志, 2017, 32(6): 425-429. DOI: 10.3760/cma.j.issn.2095-428X.2017.06.007. 5 Mannes M, Schmidt CQ, Nilsson B, et al. Complement as driver of systemic inflammation and organ failure in trauma, burn, and sepsis[J]. Semin Immunopathol, 2021, 43(6): 773-788. PMID: 34191093. PMCID: PMC8243057. DOI: 10.1007/s00281-021-00872-x. 6 中华医学会儿科学分会急救学组, 中华医学会急诊医学分会儿科学组, 中国医师协会儿童重症医师分会. 儿童脓毒性休克（感染性休克）诊治专家共识（2015版）[J]. 中国小儿急救医学, 2015, 22(11): 739-743. DOI: 10.3760/cma.j.issn.1673-4912.2015.11.001. 7 Weiss SL, Fitzgerald JC, Pappachan J, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study[J]. Am J Respir Crit Care Med, 2015, 191(10): 1147-1157. PMID: 25734408. PMCID: PMC4451622. DOI: 10.1164/rccm.201412-2323OC. 8 Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J]. Intensive Care Med, 2021, 47(11): 1181-1247. PMID: 34599691. PMCID: PMC8486643. DOI: 10.1007/s00134-021-06506-y. 9 中国研究型医院学会休克与脓毒症专业委员会, 中国人民解放军重症医学专业委员会, 重症免疫研究协作组, 等. 脓毒症免疫抑制诊治专家共识[J]. 中华危重病急救医学, 2020, 32(11): 1281-1289. PMID: 33463483. DOI: 10.3760/cma.j.cn121430-20201123-00719. 10 王斐, 缪惠洁, 王春霞, 等. 儿童严重脓毒症免疫功能的变化[J]. 中国小儿急救医学, 2017, 24(8): 561-565. DOI: 10.3760/cma.j.issn.1673-4912.2017.08.001. 11 黄圣宇, 郭光华, 朱峰. 补体系统在创伤后免疫中作用的研究进展[J]. 中华创伤杂志, 2022, 38(9): 857-864. DOI: 10.3760/cma.j.cn501098-20220530-00408. 12 Flierl MA, Rittirsch D, Nadeau BA, et al. Functions of the complement components C3 and C5 during sepsis[J]. FASEB J, 2008, 22(10): 3483-3490. PMID: 18587006. PMCID: PMC2537435. DOI: 10.1096/fj.08-110595. 13 Lei W, Ren Z, Su J, et al. Immunological risk factors for sepsis-associated delirium and mortality in ICU patients[J]. Front Immunol, 2022, 13: 940779. PMID: 36203605. PMCID: PMC9531264. DOI: 10.3389/fimmu.2022.940779. 14 Eichenberger EM, Dagher M, Ruffin F, et al. Complement levels in patients with bloodstream infection due to Staphylococcus aureus or gram-negative bacteria[J]. Eur J Clin Microbiol Infect Dis, 2020, 39(11): 2121-2131. PMID: 32621149. PMCID: PMC7334117. DOI: 10.1007/s10096-020-03955-z. 15 Ren J, Zhao Y, Yuan Y, et al. Complement depletion deteriorates clinical outcomes of severe abdominal sepsis: a conspirator of infection and coagulopathy in crime?[J]. PLoS One, 2012, 7(10): e47095. PMID: 23091606. PMCID: PMC3473032. DOI: 10.1371/journal.pone.0047095. 16 Fattahi F, Zetoune FS, Ward PA. Complement as a major inducer of harmful events in infectious sepsis[J]. Shock, 2020, 54(5): 595-605. PMID: 32187106. PMCID: PMC9704109. DOI: 10.1097/SHK.0000000000001531. 17 Luo S, Hu D, Wang M, et al. Complement in hemolysis- and thrombosis- related diseases[J]. Front Immunol, 2020, 11: 1212. PMID: 32754149. PMCID: PMC7366831. DOI: 10.3389/fimmu.2020.01212. 18 Noris M, Mescia F, Remuzzi G. STEC-HUS, atypical HUS and TTP are all diseases of complement activation[J]. Nat Rev Nephrol, 2012, 8(11): 622-633. PMID: 22986360. DOI: 10.1038/nrneph.2012.195. 19 Amara U, Flierl MA, Rittirsch D, et al. Molecular intercommunication between the complement and coagulation systems[J]. J Immunol, 2010, 185(9): 5628-5636. PMID: 20870944. PMCID: PMC3123139. DOI: 10.4049/jimmunol.0903678. 20 Lupu F, Keshari RS, Lambris JD, et al. Crosstalk between the coagulation and complement systems in sepsis[J]. Thromb Res, 2014, 133 Suppl 1(0 1): S28-S31. PMID: 24759136. PMCID: PMC4154483. DOI: 10.1016/j.thromres.2014.03.014. 21 Abe T, Kubo K, Izumoto S, et al. Complement activation in human sepsis is related to sepsis-induced disseminated intravascular coagulation[J]. Shock, 2020, 54(2): 198-204. PMID: 31917735. DOI: 10.1097/SHK.0000000000001504. 22 Zhao X, Chen YX, Li CS. Predictive value of the complement system for sepsis-induced disseminated intravascular coagulation in septic patients in emergency department[J]. J Crit Care, 2015, 30(2): 290-295. PMID: 25547047. DOI: 10.1016/j.jcrc.2014.11.007. 23 Charchaflieh J, Wei J, Labaze G, et al. The role of complement system in septic shock[J]. Clin Dev Immunol, 2012, 2012: 407324. PMID: 23049598. PMCID: PMC3459296. DOI: 10.1155/2012/407324. 24 Mannes M, Mastellos DC, Ekdahl KN, et al. Complement C3 activation in the ICU: disease and therapy as Bonnie and Clyde[J]. Semin Immunol, 2022, 60: 101640. PMID: 35853795. DOI: 10.1016/j.smim.2022.101640. 25 de Nooijer AH, Kotsaki A, Kranidioti E, et al. Complement activation in severely ill patients with sepsis: no relationship with inflammation and disease severity[J]. Crit Care, 2023, 27(1): 63. PMID: 36797757. PMCID: PMC9933299. DOI: 10.1186/s13054-023-04344-6.
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