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儿童重症监护病房急性胃肠炎伴严重脱水患儿死亡的预测因素。

Predictors of Mortality in Children Admitted to the Pediatric Intensive Care Unit with Acute Gastroenteritis with Severe Dehydration.

机构信息

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Indian J Pediatr. 2019 Dec;86(12):1142-1145. doi: 10.1007/s12098-019-03094-0. Epub 2019 Nov 7.

Abstract

The objective of the present study was to identify risk factors for mortality at admission in children admitted to the Pediatric Intensive Care Unit (PICU) with acute gastroenteritis (AGE) with severe dehydration and shock. This was a retrospective chart review of all cases of AGE with severe dehydration and shock admitted to the PICU from 2012 to 2017. Children who died during hospital stay were compared with those who survived. A total of 62 children were admitted with AGE to the PICU during this period. Twenty-four children (39%) died. The following variables were found to be significantly associated with death on univariate analysis: clinical pallor (p = 0.01), thrombocytopenia (p = 0.018), elevated leucocyte count (p = 0.02), hypoalbuminemia (p = 0.02) and severe acute malnutrition (SAM) (p = 0.04). On multivariate analysis, only hypoalbuminemia {RR [95% CI: 2.6 (1.27 to 9.21)]; 0.039} and SAM {RR [95% CI: 4.9 (1.12 to 10)]; 0.045} remained statistically significant. Children admitted with severe dehydration and shock had high mortality rates. These children were a sicker subset with probable sepsis. Severe acute malnutrition and hypoalbuminemia were associated with increased risk of death in these patients.

摘要

本研究旨在确定因急性肠胃炎(AGE)伴严重脱水和休克而入住儿科重症监护病房(PICU)的患儿入院时死亡的危险因素。这是对 2012 年至 2017 年期间因严重脱水和休克入住 PICU 的所有 AGE 患儿的回顾性图表审查。将住院期间死亡的患儿与存活的患儿进行比较。在此期间,共有 62 例 AGE 患儿入住 PICU,其中 24 例(39%)死亡。单因素分析发现以下变量与死亡显著相关:临床苍白(p=0.01)、血小板减少症(p=0.018)、白细胞计数升高(p=0.02)、低白蛋白血症(p=0.02)和严重急性营养不良(SAM)(p=0.04)。多因素分析显示,仅低白蛋白血症{RR [95%CI:2.6(1.27 至 9.21)];0.039}和 SAM{RR [95%CI:4.9(1.12 至 10)];0.045}具有统计学意义。因严重脱水和休克而入院的患儿死亡率较高。这些患儿是更严重的亚组,可能患有败血症。严重急性营养不良和低白蛋白血症与这些患者死亡风险增加相关。

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