Division of Rheumatology, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Pediatr Crit Care Med. 2012 May;13(3):e181-6. doi: 10.1097/PCC.0b013e318238955c.
This study describes the 15-yr experience of a large urban tertiary care children's hospital in treating critically ill patients with pediatric rheumatic diseases.
Retrospective case series.
Children's Hospital Los Angeles, a large urban tertiary care children's hospital.
All patients with pediatric rheumatic diseases admitted to the Children's Hospital Los Angeles pediatric intensive care unit from January 1995 to July 2009.
None.
An internal database and medical records were reviewed for demographics, diagnoses, treatments, organ dysfunction, interventions, infections, and outcomes. Standardized mortality ratio was calculated based on Pediatric Risk of Mortality III estimated mortality. Factors associated with mortality were identified by univariate analyses.Ninety patients with 122 total admissions were identified. The majority of patients were Hispanic (63%), female (73%), and had systemic lupus erythematosus (62%). Pediatric rheumatic disease-related complications (50%) were the most common reason for admission; 32% of admissions involved multiorgan dysfunction. Eighteen admissions (15%) resulted in mortality. Deaths were most commonly attributed to combined infection and active rheumatic disease (50%), infection only (22%), rheumatic disease only (11%), or other causes (17%). In 30 (25%) admissions, a new rheumatologic diagnosis was established. Standardized mortality ratio was 0.72 (95% confidence interval 0.38-1.25) for pediatric rheumatic disease patients compared to 0.87 (95% confidence interval 0.79-0.96) for all pediatric intensive care unit patients. Factors associated with mortality included use of mechanical ventilation, vasopressors, and renal replacement (continuous venovenous hemodialysis) (all p < .05).
Pediatric rheumatic disease-related complications were the principal cause of pediatric intensive care unit admission. Deaths occurred most often from severe infections in patients with active rheumatic disease. Pediatric rheumatology patients admitted to the pediatric intensive care unit had outcomes similar to the global pediatric intensive care unit population when adjusted for severity of illness.
本研究描述了一家大型城市三级儿童保健医院在治疗患有儿科风湿病的危重症患者方面的 15 年经验。
回顾性病例系列。
洛杉矶儿童医院，一家大型城市三级儿童保健医院。
2009 年 7 月 1 日至 1995 年 1 月期间，所有因儿科风湿病入住洛杉矶儿童医院儿科重症监护病房的患者。
无。
通过内部数据库和病历回顾了人口统计学、诊断、治疗、器官功能障碍、干预、感染和结局。根据儿科危重病风险 III 估计死亡率计算标准化死亡率比。通过单变量分析确定与死亡率相关的因素。共确定 90 例患者 122 例次住院。大多数患者为西班牙裔（63%）、女性（73%），且患有红斑狼疮（62%）。儿科风湿病相关并发症（50%）是最常见的入院原因；32%的入院涉及多器官功能障碍。18 例（15%）死亡。死亡最常见的原因是感染合并活动性风湿病（50%）、单纯感染（22%）、单纯风湿病（11%）或其他原因（17%）。在 30 例（25%）入院中，确定了新的风湿病诊断。与所有儿科重症监护病房患者（0.87 [95%置信区间 0.79-0.96]）相比，儿科风湿病患者的标准化死亡率比为 0.72（95%置信区间 0.38-1.25）。与死亡率相关的因素包括机械通气、血管加压素和肾脏替代治疗（连续静脉-静脉血液透析）的使用（均 p <.05）。
儿科风湿病相关并发症是儿科重症监护病房入院的主要原因。死亡最常发生在患有活动性风湿病的严重感染患者中。调整疾病严重程度后，入住儿科重症监护病房的儿科风湿病患者的结局与全球儿科重症监护病房人群相似。
