Maat Martine, Buysse Corinne M P, Emonts Marieke, Spanjaard Lodewijk, Joosten Koen F M, de Groot Ronald, Hazelzet Jan A
Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Dr, Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
Crit Care. 2007;11(5):R112. doi: 10.1186/cc6161.
To gain insight into factors that might affect results of future case-control studies, we performed an analysis of children with sepsis and purpura admitted to the paediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital (Rotterdam, The Netherlands).
Between 1988 and 2006, all 287 children consecutively admitted with sepsis and purpura were included in various sepsis studies. Data regarding age, gender, ethnicity, serogroup of Neisseria meningitidis, severity, therapy, and survival were collected prospectively. These data were pooled into one database and analyzed retrospectively.
The case fatality rate (CFR) from sepsis and purpura was 15.7%. During the study period, survival improved significantly. Younger age was significantly associated with more severe disease and a higher CFR. Children under the median age of 3.0 years had an increased risk of case fatality (odds ratio 4.3, 95% confidence interval 2.1 to 9.2; p < 0.001). Gender was not associated with CFR. However, males did have higher Paediatric Risk of Mortality scores, fewer PICU-free days, and more presence of shock. The course of sepsis and purpura was not related to ethnic origin. A causative organism was isolated in 84.3% of cases. N. meningitidis was the major organism (97.5%). Although N. meningitidis serogroup B was observed more often in younger children, serogroups were not associated with severity or survival. During the study period, the use of inotropic agents and corticosteroids changed substantially (less dopamine and more dobutamine, norepinephrine, and corticosteroids).
Age and gender are determinants of severity of paediatric sepsis and purpura. Survival rates have improved during the last two decades.
为深入了解可能影响未来病例对照研究结果的因素，我们对入住伊拉斯姆斯医学中心索菲亚儿童医院（荷兰鹿特丹）儿科重症监护病房（PICU）的脓毒症和紫癜患儿进行了分析。
1988年至2006年间，所有287例因脓毒症和紫癜连续入院的患儿被纳入各项脓毒症研究。前瞻性收集了有关年龄、性别、种族、脑膜炎奈瑟菌血清群、严重程度、治疗及生存情况的数据。这些数据被汇总到一个数据库中并进行回顾性分析。
脓毒症和紫癜的病死率（CFR）为15.7%。在研究期间，生存率显著提高。年龄较小与病情更严重及更高的病死率显著相关。年龄中位数小于3.0岁的儿童病死率风险增加（优势比4.3，95%置信区间2.1至9.2；p<0.001）。性别与病死率无关。然而，男性的儿科死亡风险评分更高，无PICU天数更少，休克情况更多见。脓毒症和紫癜的病程与种族起源无关。84.3%的病例分离出致病微生物。脑膜炎奈瑟菌是主要病原体（97.5%）。虽然在年幼儿童中更常观察到B群脑膜炎奈瑟菌，但血清群与严重程度或生存情况无关。在研究期间，血管活性药物和皮质类固醇的使用发生了很大变化（多巴胺使用减少，多巴酚丁胺、去甲肾上腺素和皮质类固醇使用增加）。
年龄和性别是儿童脓毒症和紫癜严重程度的决定因素。在过去二十年中生存率有所提高。
Zotero 插件
