危重症患儿免疫系统功能障碍标准：PODIUM 共识会议。

Immune System Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference.

机构信息

Division of Critical Care Medicine, Department of Pediatrics, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.

Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.

出版信息

Pediatrics. 2022 Jan 1;149(1 Suppl 1):S91-S98. doi: 10.1542/peds.2021-052888N.

DOI:10.1542/peds.2021-052888N

PMID:34970674

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9166150/

Abstract

CONTEXT

Immune system dysfunction is poorly represented in pediatric organ dysfunction definitions.

OBJECTIVE

To evaluate evidence for criteria that define immune system dysfunction in critically ill children and associations with adverse outcomes and develop consensus criteria for the diagnosis of immune system dysfunction in critically ill children.

DATA SOURCES

We conducted electronic searches of PubMed and Embase from January 1992 to January 2020, using medical subject heading terms and text words to define immune system dysfunction and outcomes of interest.

STUDY SELECTION

Studies of critically ill children with an abnormality in leukocyte numbers or function that is currently measurable in the clinical laboratory in which researchers assessed patient-centered outcomes were included. Studies of adults or premature infants, animal studies, reviews and commentaries, case series (≤10 subjects), and studies not published in English with inability to determine eligibility criteria were excluded.

DATA EXTRACTION

Data were abstracted from eligible studies into a standard data extraction form along with risk of bias assessment by a task force member.

RESULTS

We identified the following criteria for immune system dysfunction: (1) peripheral absolute neutrophil count <500 cells/μL, (2) peripheral absolute lymphocyte count <1000 cells/μL, (3) reduction in CD4+ lymphocyte count or percentage of total lymphocytes below age-specific thresholds, (4) monocyte HLA-DR expression <30%, or (5) reduction in ex vivo whole blood lipopolysaccharide-induced TNFα production capacity below manufacturer-provided thresholds.

LIMITATIONS

Many measures of immune system function are currently limited to the research environment.

CONCLUSIONS

We present consensus criteria for the diagnosis of immune system dysfunction in critically ill children.

摘要

背景

免疫系统功能障碍在儿科器官功能障碍定义中表现不佳。

目的

评估定义危重病儿童免疫系统功能障碍的标准的证据，并评估其与不良结局的关联，制定诊断危重病儿童免疫系统功能障碍的共识标准。

数据来源

我们对 1992 年 1 月至 2020 年 1 月的 PubMed 和 Embase 进行了电子检索，使用医学主题词和文本词来定义免疫系统功能障碍和感兴趣的结局。

研究选择

纳入了白细胞数量或功能异常的危重病儿童的研究，这些异常目前可在临床实验室中测量，研究人员评估了以患者为中心的结局。排除了成人或早产儿、动物研究、综述和评论、病例系列（≤10 例）以及未以英文发表且无法确定入选标准的研究。

数据提取

从合格研究中提取数据，并由任务组成员对风险进行偏倚评估。

结果

我们确定了以下免疫系统功能障碍的标准：（1）外周绝对中性粒细胞计数<500 个/μL，（2）外周绝对淋巴细胞计数<1000 个/μL，（3）CD4+淋巴细胞计数或总淋巴细胞百分比低于年龄特异性阈值，（4）单核细胞 HLA-DR 表达<30%，或（5）体外全血脂多糖诱导 TNFα产生能力低于制造商提供的阈值。