Nutrition Department, Federal University of Santa Catarina, Florianópolis, Brazil.
Federal University of Santa Catarina, Florianópolis, Brazil.
J Hum Nutr Diet. 2021 Apr;34(2):365-373. doi: 10.1111/jhn.12798. Epub 2020 Aug 7.
Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS-ped) and to verify its association with clinical outcomes.
A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS-ped, based on adult definition, was described. PICS-ped was defined as PICU length of stay >14 days; C-reactive protein > 10.0 mg L ; lymphocytes <25%; and any reduction of mid-upper arm circumference Z-score. Clinical, demographic, nutritional status, nutrition therapy parameters and clinical outcomes were assessed. Statistical analysis comprised Mann-Whitney and Fisher's chi-squared tests, as well as logistic and Cox regression. P < 0.05 was considered statistically significant.
In total, 153 children were included, with a median age of 51.7 months (interquartile range 15.6-123.4 months), and 60.8% male. The mortality rate was 10.5%. The prevalence of PICS-ped was 4.6%. Days using vasoactive drugs and days using antibiotics were associated with PICS-ped. PICS-ped was associated with mortality in crude (odds ratio = 6.67; P = 0.013) and adjusted analysis (odds ratio = 7.14; P = 0.017). PICS-ped was also associated with PICU and hospital length of stay, as well as duration of mechanical ventilation. Similar results were found in a subset of critically ill children who required mechanical ventilation for more than 48 h.
Children with PICS-ped required antibiotics or vasoactive drugs for a longer period. PICS-ped was associated with poor clinical outcomes in critically ill children. More studies are needed to properly define PICS-ped for this population.
持续性炎症、免疫抑制和分解代谢综合征（PICS）已在重症成人患者中描述过，可能导致不良结局。本研究旨在描述和描述重症儿童（PICS-ped）中的 PICS，并验证其与临床结局的关系。
对儿科重症监护病房（PICU）中的 3 个月至 15 岁的儿童进行了一项前瞻性纵向研究。基于成人定义描述了 PICS-ped。PICS-ped 定义为 PICU 住院时间>14 天；C 反应蛋白>10.0mg/L；淋巴细胞<25%；以及中上臂周长 Z 分数的任何降低。评估了临床、人口统计学、营养状况、营养治疗参数和临床结局。统计分析包括 Mann-Whitney 和 Fisher's chi-squared 检验，以及逻辑和 Cox 回归。P<0.05 被认为具有统计学意义。
共纳入 153 名儿童，中位年龄为 51.7 个月（四分位距 15.6-123.4 个月），60.8%为男性。死亡率为 10.5%。PICS-ped 的患病率为 4.6%。使用血管活性药物的天数和使用抗生素的天数与 PICS-ped 相关。PICS-ped 在粗分析（优势比=6.67；P=0.013）和调整分析（优势比=7.14；P=0.017）中与死亡率相关。PICS-ped 还与 PICU 和住院时间以及机械通气时间相关。在需要机械通气超过 48 小时的重症儿童亚组中也发现了类似的结果。
患有 PICS-ped 的儿童需要更长时间的抗生素或血管活性药物治疗。PICS-ped 与重症儿童的不良临床结局相关。需要更多的研究来为该人群正确定义 PICS-ped。
