Department of Pediatrics, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyonkarahisar, Turkey.
Turk J Pediatr. 2022;64(4):708-716. doi: 10.24953/turkjped.2022.170.
The main goal of septic shock therapy is to keep hemodynamic parameters in the normal range for adequate tissue perfusion. Persistent lactic acidemia has increased mortality. We evaluate the association between vasoactive-inotropic score (VIS) and lactate clearance (LC) to predict mortality of septic shock in children.
This is a retrospective study of consecutive septic shock in children admitted to the pediatric intensive care unit. Vital signs, laboratory values, and VIS were obtained at admission and the 6th hour of hospitalization. LC was calculated at the 6th hour. The associations between LC and VIS were evaluated using univariate and multivariate analysis. Receiver operating characteristic analysis was used to describe the cutoff values of LC and VIS.
Eighty-two children, age 82.3 ± 59.8 months, were included, with an overall lactate clearance of 29 ± 26%, and a mortality rate of 25.6%. The optimal cutoff value of LC was 20%. Children with LC ≥ 20% compared with LC < 20% had a lower VIS [(21.41 ± 8.36) vs. (27.48 ± 10.11) (p: 0.009)]. In multivariate comparison, PELOD score and VIS were significantly associated with 6-hour lactate clearance < 20% but VIS at 6 hours had a significant inverse relationship with LC < 20%. The cutoff for VIS was ≥ 16.2 for prognosticating the 6-hour LC and the high VIS group had a significantly lower LC and higher mortality ratio than the low VIS group.
High VIS was associated with lower lactate clearance and has been described as a predictor of greater mortality among septic shock in children.
脓毒性休克治疗的主要目标是将血流动力学参数维持在正常范围内，以确保组织灌注充足。乳酸酸中毒持续存在与死亡率增加有关。我们评估了血管活性-正性肌力评分（VIS）与乳酸清除率（LC）之间的关系，以预测儿童脓毒性休克的死亡率。
这是一项对儿科重症监护病房收治的连续脓毒性休克患儿的回顾性研究。入院时和住院第 6 小时记录生命体征、实验室值和 VIS。在第 6 小时计算 LC。使用单变量和多变量分析评估 LC 与 VIS 之间的关系。使用受试者工作特征分析描述 LC 和 VIS 的截断值。
共纳入 82 例年龄 82.3±59.8 个月的患儿，总体乳酸清除率为 29±26%，死亡率为 25.6%。LC 的最佳截断值为 20%。与 LC<20%的患儿相比，LC≥20%的患儿 VIS 较低[(21.41±8.36)比(27.48±10.11)，p：0.009)]。多变量比较显示，PELOD 评分和 VIS 与 6 小时乳酸清除率<20%显著相关，但 6 小时 VIS 与 LC<20%呈显著负相关。VIS 的截断值≥16.2 可预测 6 小时 LC<20%，高 VIS 组的 LC 较低，死亡率较高。
高 VIS 与低乳酸清除率相关，已被描述为儿童脓毒性休克死亡率增加的预测指标。
