Zhang Xuepeng, Sun Kaibo, Lu Guoyan, Feng Liwei, Chen Siyuan, Ji Yi
Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.
Front Pediatr. 2021 Feb 25;9:628918. doi: 10.3389/fped.2021.628918. eCollection 2021.
The definition is considered to lack specificity and may lead to the admission of low-risk patients to the pediatric intensive care unit (PICU). The aim of this study was to compare the PICU cost and the severity-adjusted cost between patients with sepsis defined by the and those diagnosed using the age-adapted Sepsis-3 criteria. Septic children identified by the were screened for enrollment. The enrolled children were stratified into two subgroups using the age-adapted Sepsis 3.0 definition. A comparison was made between the subgroups of sepsis 3.0-defined children and non-sepsis 3.0-defined septic children. The Severity Adjusted ICU Cost (SAIC) was used to evaluate the case-mixed severity-adjusted costs of the study population. Coefficients in linear regression analyses in subgroups were calculated for presenting variation of PICU costs for every unit change of PRISM score. A total of 397 children were enrolled. The PICU length of stay was longer in the sepsis 3.0 group than in the non-sepsis 3.0 group [median (IQR), 9.0 (5.0, 15.0) vs. 6.0 (3.0, 9.0); < 0.001]. Pediatric risk of mortality (PRISM) scores and mortality were significantly higher in sepsis 3.0-defined septic patients. The total costs and daily costs in the PICU were both significantly lower in the non-sepsis 3.0 group ( < 0.001). The severity-adjusted ICU cost in the non-sepsis 3.0 group was lower than that in the sepsis 3.0 group [median (IQR), 7,125 (3,588, 11,134) vs. 9,364 (5,680, 15,876); = 0.001]. There was no significant difference among the regression coefficients. The definition does not lead to more PICU costs after considering illness severity. www.ClinicalTrials.gov, identifier: NCT03598127.
该定义被认为缺乏特异性，可能导致低风险患者被收入儿科重症监护病房（PICU）。本研究的目的是比较根据[未提及的标准]定义的脓毒症患者与使用年龄适应性脓毒症-3标准诊断的患者之间的PICU成本和严重程度调整后的成本。筛选出根据[未提及的标准]确定的脓毒症儿童进行入组。使用年龄适应性脓毒症3.0定义将入组儿童分层为两个亚组。对脓毒症3.0定义的儿童亚组和非脓毒症3.0定义的脓毒症儿童进行比较。使用严重程度调整后的ICU成本（SAIC）来评估研究人群的病例组合严重程度调整后的成本。计算亚组线性回归分析中的系数，以呈现PRISM评分每单位变化时PICU成本的变化。共入组397名儿童。脓毒症3.0组的PICU住院时间长于非脓毒症3.0组[中位数（四分位间距），9.0（5.0，15.0）对6.0（3.0，9.0）；P<0.001]。脓毒症3.0定义的脓毒症患者的儿科死亡风险（PRISM）评分和死亡率显著更高。非脓毒症3.0组的PICU总成本和每日成本均显著更低（P<0.001）。非脓毒症3.0组的严重程度调整后的ICU成本低于脓毒症3.0组[中位数（四分位间距），7125（3588，11134）对9364（5680，15876）；P = 0.001]。回归系数之间无显著差异。在考虑疾病严重程度后，[未提及的标准]定义不会导致更多的PICU成本。ClinicalTrials.gov，标识符：NCT03598127。
