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):329-337. doi: 10.1097/CCM.0000000000004123.
In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quality of life morbidity for children encountering community-acquired septic shock.
Prospective, cohort-outcome study, conducted 2013-2017.
Twelve academic PICUs in the United States.
Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.
Demographic, infection, illness severity, organ dysfunction, and resource utilization data were collected daily during PICU admission. Serial parent proxy-report health-related quality of life assessments were obtained at baseline, 7 days, and 1, 3, 6, and 12 months following PICU admission utilizing the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale.
Among 389 children enrolled, mean age was 7.4 ± 5.8 years; 46% were female; 18% were immunocompromised; and 51% demonstrated chronic comorbidities. Baseline Pediatric Overall Performance Category was normal in 38%. Median (Q1-Q3) Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores at PICU admission were 11.0 (6.0-17.0) and 9.0 (6.0-11.0); durations of vasoactive-inotropic and mechanical ventilation support were 3.0 days (2.0-6.0 d) and 8.0 days (5.0-14.0 d); and durations of PICU and hospital stay were 9.4 days (5.6-15.4 d) and 15.7 days (9.2-26.0 d). At 1, 3, 6, and 12 months following PICU admission for the septic shock event, 8%, 11%, 12%, and 13% of patients had died, while 50%, 37%, 30%, and 35% of surviving patients had not regained their baseline health-related quality of life.
This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality of life morbidity among children encountering community-acquired septic shock. Although in-hospital mortality was 9%, 35% of survivors demonstrated significant, health-related quality of life deterioration from baseline that persisted at least 1 year following hospitalization for septic shock.
院内儿科脓毒症死亡率已大幅下降，但最初存活的脓毒症患儿的长期死亡率和发病率仍不得而知。因此，开展了儿童脓毒症后评估研究，以描述社区获得性感染性休克患儿的死亡率和健康相关生活质量发病率的变化轨迹。
前瞻性队列研究，2013 年至 2017 年进行。
美国 12 家学术儿童重症监护病房。
患有需要血管活性-正性肌力支持的社区获得性感染性休克的危重病儿童，年龄 1 个月至 18 岁。
在儿童重症监护病房住院期间，每天采集人口统计学、感染、疾病严重程度、器官功能障碍和资源利用数据。在儿童重症监护病房入院后 1、3、6 和 12 个月，利用儿童生活质量量表或 Stein-Jessop 功能状态量表，对儿童进行了基线、7 天、1、3、6 和 12 个月的连续父母代理报告健康相关生活质量评估。
在纳入的 389 名儿童中，平均年龄为 7.4±5.8 岁；46%为女性；18%免疫功能低下；51%存在慢性合并症。儿童总体表现类别基线正常的占 38%。儿童死亡风险评分和儿童逻辑器官功能障碍评分的中位数（Q1-Q3）在儿童重症监护病房入院时分别为 11.0（6.0-17.0）和 9.0（6.0-11.0）；血管活性-正性肌力支持和机械通气支持的持续时间分别为 3.0 天（2.0-6.0 d）和 8.0 天（5.0-14.0 d）；儿童重症监护病房和住院的持续时间分别为 9.4 天（5.6-15.4 d）和 15.7 天（9.2-26.0 d）。在儿童重症监护病房入院后 1、3、6 和 12 个月，8%、11%、12%和 13%的患者死亡，而存活患者中 50%、37%、30%和 35%未恢复基线健康相关生活质量。
该研究首次纵向描述了社区获得性感染性休克患儿的长期死亡率和临床相关的健康相关生活质量发病率。尽管院内死亡率为 9%，但 35%的幸存者的健康相关生活质量从基线显著恶化，且至少在感染性休克住院后 1 年仍持续存在。
