Leclerc Francis, Leteurtre Stéphane, Duhamel Alain, Grandbastien Bruno, Proulx François, Martinot Alain, Gauvin France, Hubert Philippe, Lacroix Jacques
Service de Réanimation Pédiatrique, Hôpital Jeanne de Flandre, 59037 Lille, France.
Am J Respir Crit Care Med. 2005 Feb 15;171(4):348-53. doi: 10.1164/rccm.200405-630OC. Epub 2004 Oct 29.
The interaction between sepsis and multiple organ dysfunction syndrome is poorly defined in children. We analyzed by Cox regression models the cumulative influence of organ dysfunctions, using the pediatric logistic organ dysfunction (PELOD) score, and septic state (systemic inflammatory response syndrome or sepsis, severe sepsis, and septic shock) on mortality of critically ill children. We included 593 children (mortality rate: 8.6%) from three pediatric intensive care units; 514 patients had at least a systemic inflammatory response syndrome and 269 had two or more organ dysfunctions. Hazard ratio of death significantly increased with the severity of organ dysfunction, as estimated by the PELOD score, and the worst diagnostic category of septic state. Each increase of one unit in the PELOD score multiplied the hazard ratio by 1.096 (p < 0.0001); hazard ratio of diagnostic category was 9.039 (p = 0.031) for systemic inflammatory response syndrome or sepsis, 18.797 (p = 0.007) for severe sepsis and 32.572 (p < 0.001) for septic shock. Cumulative hazard ratio of death = (hazard ratio of PELOD score) x (hazard ratio of diagnostic category). We conclude that there is a cumulative accrual of the risk of death both with an increasing severity of organ dysfunction and an increasing severity of the diagnostic category of septic state.
脓毒症与多器官功能障碍综合征之间的相互作用在儿童中尚未明确界定。我们使用儿科逻辑器官功能障碍（PELOD）评分，通过Cox回归模型分析了器官功能障碍的累积影响以及脓毒症状态（全身炎症反应综合征或脓毒症、严重脓毒症和脓毒性休克）对危重症儿童死亡率的影响。我们纳入了来自三个儿科重症监护病房的593名儿童（死亡率：8.6%）；514例患者至少有全身炎症反应综合征，269例有两个或更多器官功能障碍。根据PELOD评分估计，死亡风险比随器官功能障碍的严重程度以及脓毒症状态的最严重诊断类别而显著增加。PELOD评分每增加一个单位，风险比乘以1.096（p<0.0001）；全身炎症反应综合征或脓毒症的诊断类别风险比为9.039（p=0.031），严重脓毒症为18.797（p=0.007），脓毒性休克为32.572（p<0.001）。死亡累积风险比=（PELOD评分风险比）×（诊断类别风险比）。我们得出结论，随着器官功能障碍严重程度的增加以及脓毒症状态诊断类别的严重程度增加，死亡风险会累积增加。
