Czaja Angela S, Zimmerman Jerry J, Nathens Avery B
Children's Hospital, Critical Care, Mail Stop 8414, Ed-2 South, Room 4126, 13121 E 17th Ave, PO Box 6508, Aurora, CO 80045, USA.
Pediatrics. 2009 Mar;123(3):849-57. doi: 10.1542/peds.2008-0856.
Pediatric severe sepsis remains a significant health problem with hospital mortality up to 10%. However, there is little information about later health outcomes or needs of survivors. Therefore, our goal was to evaluate the rates of and risk factors for rehospitalization and late mortality among survivors of pediatric severe sepsis.
This was a population-based retrospective cohort study of survivors of pediatric severe sepsis (age 1 month to 18 years) in Washington State over the years 1990-2004. The sentinel admission was linked to subsequent death or episodes of hospitalization. The main outcome measures were readmission and/or late death after surviving an initial hospitalization with severe sepsis. Risk factors for readmission or death were identified by using a multivariate extended Cox model.
Overall, 7183 children were admitted with severe sepsis, 6.8% of whom died during the sentinel admission or within 28 days of discharge, whereas an additional 6.5% died subsequently. Almost half (47%) of the survivors were readmitted at least once (median: 3) after a median of 3 months, and the majority of these readmissions were emergent. Sentinel admission factors independently associated with both adverse outcomes were neurologic or hematologic organ dysfunction, government-based insurance, as well as several coexisting health conditions. In addition, age less than 1 year at the time of sepsis and bloodstream and cardiovascular infections were highly associated with subsequent readmission.
Late death occurred with similar frequency as early death associated with hospitalization with severe sepsis. Almost half of the pediatric patients suffering from an episode of severe sepsis had at least 1 subsequent hospitalization, two thirds of which were emergent or urgent. These data suggest that late outcomes after an episode of severe sepsis are poor and call for the evaluation of interventions designed to reduce later morbidity and mortality.
小儿严重脓毒症仍然是一个重大的健康问题，医院死亡率高达10%。然而，关于幸存者后期健康结局或需求的信息却很少。因此，我们的目标是评估小儿严重脓毒症幸存者再次住院率和晚期死亡率及其危险因素。
这是一项基于人群的回顾性队列研究，研究对象为1990年至2004年期间华盛顿州小儿严重脓毒症（年龄1个月至18岁）的幸存者。首次住院与随后的死亡或住院情况相关联。主要结局指标为在首次因严重脓毒症住院存活后再次入院和/或晚期死亡。采用多变量扩展Cox模型确定再次入院或死亡的危险因素。
总体而言，7183名儿童因严重脓毒症入院，其中6.8%在首次住院期间或出院后28天内死亡，另有6.5%随后死亡。几乎一半（47%）的幸存者在中位时间3个月后至少再次入院一次（中位次数：3次），且这些再次入院大多为急诊。与两种不良结局均独立相关的首次住院因素包括神经或血液系统器官功能障碍、政府医保，以及几种并存的健康状况。此外，脓毒症发生时年龄小于1岁、血流感染和心血管感染与随后再次入院高度相关。
晚期死亡的发生频率与因严重脓毒症住院相关的早期死亡相似。几乎一半经历过严重脓毒症发作的小儿患者至少有1次后续住院，其中三分之二为急诊或 urgent。这些数据表明，严重脓毒症发作后的后期结局较差，需要对旨在降低后期发病率和死亡率的干预措施进行评估。 （注：原文urgent未翻译完整，推测可能是“紧急的”意思）
