Lin John C, Spinella Philip C, Fitzgerald Julie C, Tucci Marisa, Bush Jenny L, Nadkarni Vinay M, Thomas Neal J, Weiss Scott L
1Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.2Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.3Division of Critical Care Medicine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada.4Pediatric Critical Care Medicine, Departments of Pediatrics and Public Health Sciences, Penn State University College of Medicine, Hershey, PA.
Pediatr Crit Care Med. 2017 Jan;18(1):8-16. doi: 10.1097/PCC.0000000000000978.
To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis.
Secondary analysis of a prospective, cross-sectional, point prevalence study.
International, multicenter PICUs.
Pediatric patients with severe sepsis identified on five separate days over a 1-year period.
None.
Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001).
Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.
描述重症脓毒症患儿新发或进展性多器官功能障碍综合征的流行病学、发病率及死亡率。
对一项前瞻性、横断面、现患率研究进行二次分析。
国际多中心儿科重症监护病房。
在1年期间内5个不同日期确定的重症脓毒症儿科患者。
无。
来自26个国家128个儿科重症监护病房的567例患者中，384例（68%）在确诊重症脓毒症7天内发生多器官功能障碍综合征。脓毒症确诊当天有327例发生多器官功能障碍综合征。其中91例患者发生进展性多器官功能障碍综合征，另有57例患者随后发生新发多器官功能障碍综合征，重症脓毒症相关新发或进展性多器官功能障碍综合征的总比例为26%。进展性多器官功能障碍综合征患者的医院死亡率为51%，新发多器官功能障碍综合征患者为28%，单器官功能障碍而非多器官功能障碍综合征患者为10%（p<0.001）。新发或进展性多器官功能障碍综合征幸存者中，中度至重度残疾（定义为儿科总体表现类别评分大于或等于3且较基线增加大于或等于1）的发生率也更高：进展性、新发和无多器官功能障碍综合征患者分别为22%、29%和11%（p<0.001）。
新发或进展性多器官功能障碍综合征在重症脓毒症中很常见（26%），与无新发或进展性多器官功能障碍综合征的重症脓毒症相比，其发病和死亡风险更高。我们的数据支持将新发或进展性多器官功能障碍综合征作为儿科重症脓毒症试验的重要结局指标，不过仍需努力验证减少新发或进展性多器官功能障碍综合征是否能改善更确切的发病和死亡终点。
