Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Crit Care Med. 2020 Mar;48(3):319-328. doi: 10.1097/CCM.0000000000004122.
A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes.
Prospective, cohort-outcome study, conducted 2013-2017.
Twelve United States academic PICUs.
Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.
Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale.
In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3.
Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock.
一篇相关的述评报告了儿童脓毒性休克患者长期死亡率和显著健康相关生活质量残疾的轨迹。在本文中，研究人员检查了与这些不良结局相关的危重病因素。
前瞻性队列研究，2013-2017 年进行。
美国 12 家学术 PICUs。
患有社区获得性脓毒性休克且需要血管活性-正性肌力支持的危重病儿童，年龄 1 个月至 18 岁。
在 PICU 住院期间收集疾病严重程度、器官功能障碍和资源利用数据。通过父母代理报告，使用儿科生活质量量表或 Stein-Jessop 功能状态量表评估 3 个月随访时的健康相关生活质量基线变化。
在单变量模型中，与死亡和/或持续严重健康相关生活质量恶化相关的危重病变量是使用贝叶斯信息标准进行多变量模型构建的候选因素。在具有近乎最佳统计拟合的模型中选择了最具临床相关性的多变量模型。在 389 名患者中，346 名（88.9%）在 3 个月后存活，43 名（11.1%）死亡；389 名中有 203 名完成了配对的健康相关生活质量调查。儿科死亡率风险、累积儿科逻辑器官功能评分、PICU 和住院时间、最大和累积血管活性-正性肌力评分、机械通气时间、肾脏替代治疗需求、体外生命支持或心肺复苏以及病理神经体征的出现与单变量模型中的不良结局相关。在多变量回归分析（比值比[95%CI]）中，每日儿科逻辑器官功能评分总和，每增加 1 分（1.01-1.02），p<0.001；最高血管活性-正性肌力评分，每增加 1 分（1.00-1.04），p=0.003；以及任何急性病理神经体征/事件，5.04（2.15-12.01），p<0.001，与 3 个月时的死亡或持续严重的健康相关生活质量恶化独立相关。
与脓毒症相关的危重病器官功能障碍及其治疗相关的生物学上合理的因素与儿童脓毒性休克患者 3 个月随访时的不良结局相关。
