Sandquist Mary K, Clee Mark S, Patel Smruti K, Howard Kelli A, Yunger Toni, Nagaraj Usha D, Jones Blaise V, Fei Lin, Vadivelu Sudhakar, Wong Hector R
1Division of Pediatric Critical Care, University of Louisville, Norton Children's Hospital, Louisville, KY. 2Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 3Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH. 4Division of Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 6Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Pediatr Crit Care Med. 2017 Jul;18(7):607-613. doi: 10.1097/PCC.0000000000001173.
This study was intended to describe and correlate the neuroimaging findings in pediatric patients after sepsis.
Retrospective chart review.
Single tertiary care PICU.
Patients admitted to Cincinnati Children's Hospital Medical Center with a discharge diagnosis of sepsis or septic shock between 2004 and 2013 were crossmatched with patients who underwent neuroimaging during the same time period.
All neuroimaging studies that occurred during or subsequent to a septic event were reviewed, and all new imaging findings were recorded and classified. As many patients experienced multiple septic events and/or had multiple neuroimaging studies after sepsis, our statistical analysis utilized the most recent or "final" imaging study available for each patient so that only brain imaging findings that persisted were included.
A total of 389 children with sepsis and 1,705 concurrent or subsequent neuroimaging studies were included in the study. Median age at first septic event was 3.4 years (interquartile range, 0.7-11.5). Median time from first sepsis event to final neuroimaging was 157 days (interquartile range, 10-1,054). The most common indications for final imaging were follow-up (21%), altered mental status (18%), and fever/concern for infection (15%). Sixty-three percentage (n = 243) of final imaging studies demonstrated abnormal findings, the most common of which were volume loss (39%) and MRI signal and/or CT attenuation abnormalities (21%). On multivariable logistic regression, highest Pediatric Risk of Mortality score and presence of oncologic diagnosis/organ transplantation were independently associated with any abnormal final neuroimaging study findings (odds ratio, 1.032; p = 0.048 and odds ratio, 1.632; p = 0.041), although early timing of neuroimaging demonstrated a negative association (odds ratio, 0.606; p = 0.039). The most common abnormal finding of volume loss was independently associated with highest Pediatric Risk of Mortality score (odds ratio, 1.037; p = 0.016) and oncologic diagnosis/organ transplantation (odds ratio, 2.207; p = 0.001) and was negatively associated with early timing of neuroimaging (odds ratio, 0.575; p = 0.037).
The majority of pediatric patients with sepsis and concurrent or subsequent neuroimaging have abnormal neuroimaging findings. The implications of this high incidence for long-term neurologic outcomes and follow-up require further exploration.
本研究旨在描述脓毒症患儿的神经影像学检查结果并进行相关性分析。
回顾性病历审查。
单一的三级医疗儿科重症监护病房。
2004年至2013年间因脓毒症或脓毒性休克出院诊断而入住辛辛那提儿童医院医疗中心的患者，与同期接受神经影像学检查的患者进行交叉匹配。
对脓毒症事件期间或之后进行的所有神经影像学研究进行审查，记录并分类所有新的影像学检查结果。由于许多患者经历了多次脓毒症事件和/或脓毒症后进行了多次神经影像学检查，我们的统计分析采用了每位患者可获得的最新或“最终”影像学研究，以便仅纳入持续存在的脑影像学检查结果。
本研究共纳入389例脓毒症患儿及1705项同期或后续的神经影像学研究。首次脓毒症事件时的中位年龄为3.4岁（四分位间距，0.7 - 11.5岁）。从首次脓毒症事件到最终神经影像学检查的中位时间为157天（四分位间距，10 - 1054天）。最终影像学检查的最常见指征为随访（21%）、精神状态改变（18%）以及发热/感染担忧（15%）。63%（n = 243）的最终影像学研究显示有异常发现，其中最常见的是脑容量减少（39%）以及MRI信号和/或CT衰减异常（21%）。在多变量逻辑回归分析中，最高的儿科死亡风险评分以及存在肿瘤诊断/器官移植与任何最终神经影像学检查异常发现独立相关（比值比，1.032；p = 0.048以及比值比，1.632；p = 0.041），尽管神经影像学检查的早期进行显示出负相关（比值比，0.606；p = 0.039）。脑容量减少这一最常见的异常发现与最高的儿科死亡风险评分（比值比，1.037；p = 0.016）以及肿瘤诊断/器官移植（比值比，2.207；p = 0.001）独立相关，并且与神经影像学检查的早期进行呈负相关（比值比，0.575；p = 0.037）。
大多数脓毒症患儿及同期或后续进行神经影像学检查的患儿有异常的神经影像学检查结果。这种高发生率对长期神经学结局和随访的影响需要进一步探索。
