Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Eur J Pediatr. 2020 Jul;179(7):1147-1155. doi: 10.1007/s00431-020-03610-x. Epub 2020 Feb 15.
The study objective was to analyze the association between low plasma vasopressin and progression of sepsis to septic shock in neonates < 34 weeks gestation. Septic neonates of < 34 weeks gestation were consecutively enrolled; moribund neonates and those with major malformations were excluded. Subjects were monitored for progression of sepsis to septic shock over the first 7 days from enrolment. Plasma vasopressin levels and inducible nitric oxide synthase levels were measured at the onset of sepsis (T0), severe sepsis (T1), and septic shock (T2). Primary outcome was plasma vasopressin levels at the point of sepsis in those who progressed to septic shock in comparison with matched nested controls in the non-progression group. Forty-nine (47%) enrolled subjects developed severe sepsis or septic shock. Plasma vasopressin levels (pg/ml) at the onset of sepsis were significantly low in those who progressed to septic shock (median (IQR), 31 (2.5-80) versus 100 (12-156); p = 0.02). After adjusting for confounders, vasopressin levels were independently associated with progression to septic shock (adjusted OR (95% CI), 0.97 (0.96, 0.99); p = 0.01).Conclusion: Preterm septic neonates who progressed to septic shock had suppressed vasopressin levels before the onset of shock. Low vasopressin levels were independently associated with progression to septic shock.What is known:• In animal sepsis models and adult septic patients, exuberant production of nitric oxide metabolites and low vasopressin levels have been reportedly associated with progression to septic shock.• Vasopressin levels have been variably reported as low as well as elevated in children with septic shock.What is New:• Preterm neonates who progressed from sepsis to septic shock had significantly lower levels of vasopressin before the onset of shock in comparison with those who did not progress.• Low vasopressin levels independently predicted the progression from sepsis to septic shock in this population.
研究目的是分析低血浆血管加压素与<34 周胎龄新生儿败血症进展为败血症性休克的关系。连续纳入<34 周胎龄的败血症新生儿；排除濒死和有重大畸形的新生儿。在纳入后第 1 天至第 7 天，监测新生儿败血症进展为败血症性休克的情况。在败血症（T0）、严重败血症（T1）和败血症性休克（T2）时，测量血浆血管加压素和诱导型一氧化氮合酶水平。主要结局是与非进展组匹配嵌套对照相比，进展为败血症性休克的患者在败血症时的血浆血管加压素水平。49（47%）名入组患者进展为严重败血症或败血症性休克。进展为败血症性休克的患者败血症发作时的血浆血管加压素水平（pg/ml）明显较低（中位数（IQR），31（2.5-80）与 100（12-156）；p=0.02）。调整混杂因素后，血管加压素水平与进展为败血症性休克独立相关（调整后的 OR（95%CI），0.97（0.96，0.99）；p=0.01）。结论：进展为败血症性休克的早产儿败血症患者在休克发作前即有血管加压素水平受抑制。低血管加压素水平与进展为败血症性休克独立相关。已知：• 在动物败血症模型和成人败血症患者中，过量产生的一氧化氮代谢物和低血管加压素水平与进展为败血症性休克有关。• 已有报道称，儿童败血症性休克患者的血管加压素水平降低或升高。新发现：• 与未进展为败血症性休克的患者相比，从败血症进展为败血症性休克的早产儿在休克发作前的血管加压素水平明显较低。• 在该人群中，低血管加压素水平独立预测从败血症进展为败血症性休克。
