de Souza Daniela Carla, Shieh Huei Hsin, Barreira Eliane Roseli, Ventura Andrea Maria Cordeiro, Bousso Albert, Troster Eduardo Juan
11Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitário da Universidade de São Paulo, Sao Paulo, SP, Brazil. 2Department of Pediatrics, Medical School, Universidade de São Paulo, Sao Paulo, SP, Brazil. 3Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Pediatr Crit Care Med. 2016 Aug;17(8):727-34. doi: 10.1097/PCC.0000000000000847.
To report the prevalence of sepsis within the first 24 hours at admission and the PICU sepsis-related mortality among critically ill children admitted to PICU in South America.
A prospective multicenter cohort study.
Twenty-one PICU, located in five South America countries.
All children from 29 days to 17 years old admitted to the participating PICU between June 2011 and September 2011. Clinical, demographic, and laboratory data were registered within the first 24 hours at admission. Outcomes were registered upon PICU discharge or death.
None.
Of the 1,090 patients included in this study, 464 had sepsis. The prevalence of sepsis, severe sepsis, and septic shock were 42.6%, 25.9%, and 19.8%, respectively. The median age of sepsis patients was 11.6 months (interquartile range, 3.2-48.7) and 43% had one or more prior chronic condition. The prevalence of sepsis was higher in infants (50.4%) and lower in adolescents (1.9%). Sepsis-related mortality was 14.2% and was consistently higher with increased disease severity: 4.4% for sepsis, 12.3% for severe sepsis, and 23.1% for septic shock. Twenty-five percent of deaths occurred within the first 24 hours at PICU admission. Multivariate analysis showed that higher Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, the presence of two or more chronic conditions, and admission from pediatric wards were independently associated with death.
We observed high prevalence of sepsis and sepsis-related mortality among this sample of children admitted to PICU in South America. Mortality was associated with greater severity of illness at admission and potentially associated with late PICU referral.
报告南美洲入住儿科重症监护病房（PICU）的危重症儿童入院后24小时内脓毒症的患病率及PICU中与脓毒症相关的死亡率。
一项前瞻性多中心队列研究。
位于南美洲五个国家的21个PICU。
2011年6月至2011年9月期间入住参与研究的PICU的所有29天至17岁儿童。临床、人口统计学和实验室数据在入院后24小时内记录。结局在PICU出院或死亡时记录。
无。
本研究纳入1090例患者，其中464例患有脓毒症。脓毒症、严重脓毒症和脓毒性休克的患病率分别为42.6%、25.9%和19.8%。脓毒症患者的中位年龄为11.6个月（四分位间距，3.2 - 48.7），43%的患者有一种或多种既往慢性疾病。脓毒症患病率在婴儿中较高（50.4%），在青少年中较低（1.9%）。脓毒症相关死亡率为14.2%，且随着疾病严重程度增加而持续升高：脓毒症为4.4%，严重脓毒症为12.3%，脓毒性休克为23.1%。25%的死亡发生在PICU入院后的24小时内。多变量分析显示，较高的儿童死亡风险和儿童逻辑器官功能障碍评分、存在两种或更多慢性疾病以及从儿科病房入院与死亡独立相关。
我们观察到南美洲入住PICU的这组儿童中脓毒症及脓毒症相关死亡率较高。死亡率与入院时疾病严重程度增加相关，且可能与PICU转诊延迟有关。
