Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brasil.
Unidade de Terapia Intensiva Pediátrica, Hospital Sírio-Libanês - São Paulo (SP), Brasil.
Rev Bras Ter Intensiva. 2021 Apr-Jun;33(2):231-242. doi: 10.5935/0103-507X.20210030.
To report the prevalence and outcomes of sepsis in children admitted to public and private hospitals.
Post hoc analysis of the Latin American Pediatric Sepsis Study (LAPSES) data, a cohort study that analyzed the prevalence and outcomes of sepsis in critically ill children with sepsis on admission at 21 pediatric intensive care units in five Latin American countries.
Of the 464 sepsis patients, 369 (79.5%) were admitted to public hospitals and 95 (20.5%) to private hospitals. Compared to those admitted to private hospitals, sepsis patients admitted to public hospitals did not differ in age, sex, immunization status, hospital length of stay or type of admission but had higher rates of septic shock, higher Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2), and Pediatric Logistic Organ Dysfunction (PELOD) scores, and higher rates of underlying diseases and maternal illiteracy. The proportion of patients admitted from pediatric wards and sepsis-related mortality were higher in public hospitals. Multivariate analysis did not show any correlation between mortality and the type of hospital, but mortality was associated with greater severity on pediatric intensive care unit admission in patients from public hospitals.
In this sample of critically ill children from five countries in Latin America, the prevalence of septic shock within the first 24 hours at admission and sepsis-related mortality were higher in public hospitals than in private hospitals. Higher sepsis-related mortality in children admitted to public pediatric intensive care units was associated with greater severity on pediatric intensive care unit admission but not with the type of hospital. New studies will be necessary to elucidate the causes of the higher prevalence and mortality of pediatric sepsis in public hospitals.
报告在公立和私立医院住院的儿童脓毒症的患病率和结局。
对拉丁美洲儿科脓毒症研究（LAPSES）数据进行事后分析，该队列研究分析了 5 个拉丁美洲国家的 21 个儿科重症监护病房中因入院时患有脓毒症而入住重症监护病房的危重病儿童中脓毒症的患病率和结局。
在 464 例脓毒症患者中，369 例（79.5%）入住公立医院，95 例（20.5%）入住私立医院。与私立医院入院的脓毒症患者相比，公立医院入院的脓毒症患者在年龄、性别、免疫状况、住院时间或入院类型方面无差异，但败血症休克、儿科死亡风险评分（PRISM）、儿科死亡率 2 评分（PIM 2）和儿科逻辑器官功能障碍评分（PELOD）较高，且基础疾病和产妇文盲的发生率较高。公立医院入院患者中来自儿科病房的比例和脓毒症相关死亡率较高。多变量分析显示死亡率与医院类型之间没有任何相关性，但死亡率与公立医院入院时的严重程度有关。
在来自拉丁美洲 5 个国家的危重病儿童样本中，公立和私立医院入院后 24 小时内败血症休克的患病率和脓毒症相关死亡率较高。与私立儿科重症监护病房入院的患者相比，公立医院儿科重症监护病房入院的脓毒症相关死亡率较高与儿科重症监护病房入院时的严重程度有关，而与医院类型无关。需要进一步的研究来阐明公立医院儿科脓毒症发病率和死亡率较高的原因。
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