2002-2013 年澳大利亚和新西兰重症儿童侵袭性感染、脓毒症和感染性休克相关死亡率：一项多中心回顾性队列研究。

Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study.

机构信息

Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia; Paediatric Intensive Care Unit, Mater Children's Hospital, Brisbane, QLD, Australia; Children's Critical Care Services, Gold Coast University Hospital, Southport, QLD, Australia.

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

出版信息

Lancet Infect Dis. 2015 Jan;15(1):46-54. doi: 10.1016/S1473-3099(14)71003-5. Epub 2014 Dec 1.

DOI:10.1016/S1473-3099(14)71003-5

PMID:25471555

Abstract

BACKGROUND

Severe infections kill more than 4·5 million children every year. Population-based data for severe infections in children requiring admission to intensive care units (ICUs) are scarce. We assessed changes in incidence and mortality of severe infections in critically ill children in Australia and New Zealand.

METHODS

We did a retrospective multicentre cohort study of children requiring intensive care in Australia and New Zealand between 2002 and 2013, with data from the Australian and New Zealand Paediatric Intensive Care Registry. We included children younger than 16 years with invasive infection, sepsis, or septic shock. We assessed incidence and mortality in the ICU for 2002-07 versus 2008-13.

FINDINGS

During the study period, 97 127 children were admitted to ICUs, 11 574 (11·9%) had severe infections, including 6688 (6·9%) with invasive infections, 2847 (2·9%) with sepsis, and 2039 (2·1%) with septic shock. Age-standardised incidence increased each year by an average of 0·56 cases per 100 000 children (95% CI 0·41-0·71) for invasive infections, 0·09 cases per 100 000 children (0·00-0·17) for sepsis, and 0·08 cases per 100 000 children (0·04-0·12) for septic shock. 260 (3·9%) of 6688 patients with invasive infection died, 159 (5·6%) of 2847 with sepsis died, and 346 (17·0%) of 2039 with septic shock died, compared with 2893 (3·0%) of all paediatric ICU admissions. Children admitted with invasive infections, sepsis, and septic shock accounted for 765 (26·4%) of 2893 paediatric deaths in ICUs. Comparing 2008-13 with 2002-07, risk-adjusted mortality decreased significantly for invasive infections (odds ratio 0·72, 95% CI 0·56-0·94; p=0·016), and for sepsis (0·66, 0·47-0·93; p=0·016), but not significantly for septic shock (0·79, 0·61-1·01; p=0·065).

INTERPRETATION

Severe infections remain a major cause of mortality in paediatric ICUs, representing a major public health problem. Future studies should focus on patients with the highest risk of poor outcome, and assess the effectiveness of present sepsis interventions in children.

FUNDING

National Medical Health and Research Council, Australian Resuscitation Outcomes Consortium, Centre of Research Excellence (1029983).

摘要

背景

每年有超过 450 万名儿童因严重感染而死亡。关于需要入住重症监护病房（ICU）的儿童中严重感染的基于人群的数据很少。我们评估了澳大利亚和新西兰重症儿童严重感染的发病率和死亡率的变化。

方法

我们对 2002 年至 2013 年间澳大利亚和新西兰需要重症监护的儿童进行了回顾性多中心队列研究，数据来自澳大利亚和新西兰儿科重症监护登记处。我们纳入了年龄在 16 岁以下、有侵袭性感染、败血症或感染性休克的儿童。我们评估了 2002-07 年与 2008-13 年 ICU 的发病率和死亡率。

结果

在研究期间，97127 名儿童入住 ICU，11574 名（11.9%）患有严重感染，包括 6688 名（6.9%）有侵袭性感染，2847 名（2.9%）有败血症，2039 名（2.1%）有感染性休克。每年每 10 万儿童标准化发病率平均增加 0.56 例（95%CI 0.41-0.71），侵袭性感染增加 0.09 例（0.00-0.17），败血症增加 0.08 例（0.04-0.12），感染性休克增加 0.08 例（0.04-0.12）。在 6688 名侵袭性感染患者中，260 名（3.9%）死亡，2847 名败血症患者中 159 名（5.6%）死亡，2039 名感染性休克患者中 346 名（17.0%）死亡，而所有儿科 ICU 患者中死亡 2893 名（3.0%）。因侵袭性感染、败血症和感染性休克而入住 ICU 的儿童占 2893 名儿科死亡儿童的 765 名（26.4%）。与 2002-07 年相比，侵袭性感染的风险调整死亡率显著下降（比值比 0.72，95%CI 0.56-0.94；p=0.016），败血症的死亡率也显著下降（比值比 0.66，0.47-0.93；p=0.016），但感染性休克的死亡率没有显著下降（比值比 0.79，0.61-1.01；p=0.065）。