Evaluation and prognosis prediction of serum levels of C-reactive protein and serum amyloid A in premature infants with necrotizing enterocolitis

doi:10.11958/20253327

Abstract

Abstract:

Objective To investigate the clinical value of serum C-reactive protein (CRP) and serum amyloid A (SAA) levels in evaluating the severity and predicting the prognosis of necrotizing enterocolitis (NEC) in preterm infants. Methods A total of 90 preterm infants with NEC were enrolled as the NEC group. According to the modified Bell-NEC staging criteria, the patients were divided into stage Ⅱ (49 cases) and stage Ⅲ (41 cases). In accordance with the therapeutic outcomes at 28 days after discharge, patients were categorized into the improved prognosis group (64 cases) and the poor prognosis group (26 cases). Another 90 healthy preterm infants admitted during the same period were selected as the control group. Differences in general clinical data and serum CRP and SAA levels were compared between the NEC group and the control group. The differences of CRP and SAA levels in infants with different NEC stages and their correlations with disease staging were analyzed. Receiver operating characteristic (ROC) curve was adopted to evaluate the diagnostic efficacy of serum CRP and SAA for NEC and their predictive value for prognosis. A multivariate Logistic regression model was established to control confounding factors, and to analyze the effects of the above two indicators on prognosis. Results Serum levels of CRP, SAA, procalcitonin (PCT) and interleukin (IL)-6 were significantly higher in the NEC group than those in the control group (P<0.01). Serum CRP and SAA levels in children with stage Ⅲ NEC were higher than those in stage Ⅱ (P<0.01). Spearman correlation analysis showed that serum CRP and SAA levels were significantly positively correlated with NEC stage (P<0.01). The area under the curve (AUC) for serum CRP, SAA, and their combined diagnosis of NEC were 0.883 (95%CI: 0.798-0.941), 0.863 (95%CI: 0.774-0.926), and 0.960 (95%CI: 0.896-0.990), respectively. The levels of serum CRP and SAA in the poor prognosis group were higher than those in the improved prognosis group (P<0.01).Multivariate Logistic regression analysis revealed that elevated serum CRP and SAA were both independent risk factors for poor prognosis in patients with NEC (P<0.05). The AUC (95%CI) of serum CRP, SAA and combined detection for patients with poor prognosis of NEC were 0.896 (0.813-0.951), 0.889（95%CI：0.817-0.953） and 0.951(0.884-0.986), respectively. Conclusion Serum CRP and SAA levels are positively correlated with the severity of NEC in premature infants, and their elevated levels are independent risk factors for poor prognosis of NEC premature infants.

Key words: enterocolitis, necrotizing, C-reactive protein, serum amyloid A protein, infant, premature, prognosis

CLC Number:

R722.1

Figures/Tables 9

References 20

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组别		n	性别（男/女）	胎龄/周	出生体质量/kg	羊水污染
对照组		90	49/41	28.19±2.48	1.62±0.41	19（21.11）
NEC组		90	46/44	27.94±2.31	1.57±0.33	24（26.67）
χ²或t			0.201	0.708	0.840	0.764
组别	分娩方式			妊娠期合并症		开始喂食时间/d
组别	顺产		剖宫产	高血压	糖尿病	开始喂食时间/d
对照组	25（27.78）		65（72.22）	19（21.11）	21（23.33）	3.15±1.23
NEC组	19（21.11）		71（78.89）	22（24.44）	24（26.67）	3.36±1.05
χ²	1.083			0.284	0.267	1.233

组别		n	性别（男/女）	胎龄/周	出生体质量/kg	羊水污染
对照组		90	49/41	28.19±2.48	1.62±0.41	19（21.11）
NEC组		90	46/44	27.94±2.31	1.57±0.33	24（26.67）
χ²或t			0.201	0.708	0.840	0.764
组别	分娩方式			妊娠期合并症		开始喂食时间/d
组别	顺产		剖宫产	高血压	糖尿病	开始喂食时间/d
对照组	25（27.78）		65（72.22）	19（21.11）	21（23.33）	3.15±1.23
NEC组	19（21.11）		71（78.89）	22（24.44）	24（26.67）	3.36±1.05
χ²	1.083			0.284	0.267	1.233

组别	n		围产期缺氧史		感染征象		喂养不当		输血史
对照组	90		5（5.56）		3（3.33）		4（4.44）		3（3.33）
NEC组	90		28（31.11）		62（68.89）		29（32.22）		21（23.33）
χ²			19.629^＊＊		29.829^＊＊		23.191^＊＊		15.577^＊＊
组别		CRP/（mg/L）		PCT/ （μg/L）		IL-6/ （ng/L）		SAA/ （mg/L）
对照组		14.34±3.03		0.18±0.06		27.24±5.31		102.68±42.67
NEC组		23.01±8.59		1.39±0.58		111.36±24.14		312.28±70.21
t		9.027^＊＊		19.736^＊＊		32.289^＊＊		24.202^＊＊

组别	n		围产期缺氧史		感染征象		喂养不当		输血史
对照组	90		5（5.56）		3（3.33）		4（4.44）		3（3.33）
NEC组	90		28（31.11）		62（68.89）		29（32.22）		21（23.33）
χ²			19.629^＊＊		29.829^＊＊		23.191^＊＊		15.577^＊＊
组别		CRP/（mg/L）		PCT/ （μg/L）		IL-6/ （ng/L）		SAA/ （mg/L）
对照组		14.34±3.03		0.18±0.06		27.24±5.31		102.68±42.67
NEC组		23.01±8.59		1.39±0.58		111.36±24.14		312.28±70.21
t		9.027^＊＊		19.736^＊＊		32.289^＊＊		24.202^＊＊

Bell-NEC分期	n	CRP	SAA
Ⅱ期	49	17.70±7.46	261.41±66.11
Ⅲ期	41	29.35±9.27	373.08±85.57
t		6.481^＊＊	6.824^＊＊