Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nan-Li-Shi Road, Beijing, 100045, China.
Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences (DIFMS), 2019-I2M-5-026, Beijing, China.
World J Pediatr. 2022 Nov;18(11):734-745. doi: 10.1007/s12519-022-00574-w. Epub 2022 Jun 23.
We explored the differences in baseline characteristics, pathogens, complications, outcomes, and risk factors between children with hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in the pediatric intensive care unit (PICU).
This retrospective study enrolled children with septic shock at the PICU of Beijing Children's Hospital from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into the HASS and CASS group. Logistic regression analysis was used to identify risk factors for mortality.
A total of 298 children were enrolled. Among them, 65.9% (n = 91) of HASS patients had hematologic/oncologic diseases, mainly with Gram-negative bacterial bloodstream infections (47.3%). Additionally, 67.7% (n = 207) of CASS patients had no obvious underlying disease, and most experienced Gram-positive bacterial infections (30.9%) of the respiratory or central nervous system. The 28-day mortality was 62.6% and 32.7% in the HASS and CASS groups, respectively (P < 0.001). Platelet [odds ratio (OR) = 0.996, 95% confidence interval (CI) = 0.992-1.000, P = 0.028], positive pathogen detection (OR = 3.557, 95% CI = 1.307-9.684, P = 0.013), and multiple organ dysfunction syndrome (OR = 10.953, 95% CI = 1.974-60.775, P = 0.006) were risk factors for 28-day mortality in HASS patients. Lactate (OR = 1.104, 95% CI = 1.022-1.192, P = 0.012) and mechanical ventilation (OR = 8.114, 95% CI = 1.806-36.465, P = 0.006) were risk factors for 28-day mortality in patients with CASS.
The underlying diseases, pathogens, complications, prognosis, and mortality rates varied widely between the HASS and CASS groups. The predictors of 28-day mortality were different between HASS and CASS pediatric patients with septic shock.
本研究旨在探讨儿科重症监护病房（PICU）中院内获得性脓毒性休克（HASS）和社区获得性脓毒性休克（CASS）患儿的基线特征、病原体、并发症、结局和危险因素的差异。
本回顾性研究纳入了 2016 年 1 月 1 日至 2019 年 12 月 31 日在北京儿童医院 PICU 发生脓毒性休克的患儿。对患儿进行随访，直至休克或死亡后 28 天，并将其分为 HASS 和 CASS 组。采用 logistic 回归分析识别死亡的危险因素。
共纳入 298 例患儿。其中，65.9%（n=91）的 HASS 患儿患有血液/肿瘤疾病，主要为革兰阴性菌血流感染（47.3%）。此外，67.7%（n=207）的 CASS 患儿无明显基础疾病，大多数经历革兰阳性菌引起的呼吸道或中枢神经系统感染（30.9%）。HASS 和 CASS 组的 28 天死亡率分别为 62.6%和 32.7%（P<0.001）。血小板（比值比[OR] = 0.996，95%置信区间[CI] = 0.992-1.000，P = 0.028）、阳性病原体检测（OR = 3.557，95% CI = 1.307-9.684，P = 0.013）和多器官功能障碍综合征（OR = 10.953，95% CI = 1.974-60.775，P = 0.006）是 HASS 患儿 28 天死亡率的危险因素。乳酸（OR = 1.104，95% CI = 1.022-1.192，P = 0.012）和机械通气（OR = 8.114，95% CI = 1.806-36.465，P = 0.006）是 CASS 患儿 28 天死亡率的危险因素。
HASS 和 CASS 患儿的基础疾病、病原体、并发症、预后和死亡率差异较大。HASS 和 CASS 脓毒性休克患儿 28 天死亡率的预测因素不同。
