The utility of serum total bile acid levels as a prognostic biomarker for the survival of children with sepsis

Abstract

Background: Sepsis is common in pediatric intensive care units (ICU). It is crucial to explore the independent risk factors of sepsis, establish a septic prediction model, and evaluate the prognosis of hospitalized surviving patients with sepsis through clinical research. Methods: From January 2016 to December 2021, we selected septic children admitted to the ICU of the Children's Hospital, Zhejiang University School of Medicine. Concurrently, as controls for the absence of sepsis, healthy children of the same age were chosen. Every child was categorized into one of three groups based on the prognosis of sepsis: sepsis survival, sepsis death, or a control group with no sepsis. As the subject of the study, comprehensive clinical data of all children who were admitted to the hospital were collected. In order to identify prognostic risk factors for sepsis patients in the intensive care unit, the disparities in laboratory examination outcomes and clinical indicators of sepsis among the three groups of children were compared. Results:A total of 702 children were enrolled, including 538 cases in the sepsis survival group, 164 cases in the sepsis death group, and 269 cases in the no sepsis control group. Univariate and multivariate logistic regression analysis of in-hospital mortality showed that serum total bile acid (TBA) (OR=2.898, 95% CI 1.946~4.315, p<0.05) was a risk factor for sepsis. A clinical prediction model for sepsis prognosis was constructed based on the risk factors obtained from regression analysis. We found that TBA (>17.95 µmol/L) is an independent risk factor for predicting sepsis mortality, with an area under the curve (AUC) of 0.842 (95% CI 0.800-0.883), sensitivity of 54.9%, specificity of 96.6%, and HR=7.658 (95% CI 5.575~10.520). Conclusion: It is imperative to investigate the utilization of prognostic models for the purpose of forecasting mortality in children afflicted with sepsis. Based on the findings of this study, elevated serum TBA concentrations are associated with a heightened risk of mortality in pediatric sepsis. By constructing a survival prediction model from clinical data, the final analysis can assist clinicians caring for children with sepsis at the bedside.