危重症儿童合并川崎病在儿科重症监护病房的死亡风险因素：一项多中心研究。
Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study.
机构信息
Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
Department of Pediatric Intensive Care, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
出版信息
Pediatr Res. 2023 Aug;94(2):730-737. doi: 10.1038/s41390-023-02518-0. Epub 2023 Feb 22.
BACKGROUND
This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit.
METHODS
A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome.
RESULTS
The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation.
CONCLUSIONS
In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
IMPACT
MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
背景
本研究评估了儿童重症监护病房收治的严重儿童多系统炎症综合征的临床特征、结局和死亡风险因素。
方法
这是一项于 2020 年 3 月至 2021 年 4 月在土耳其 41 个儿童重症监护病房进行的回顾性多中心队列研究。研究人群包括 322 名诊断为多系统炎症综合征的儿童。
结果
最常受累的器官系统是心血管和血液系统。294 名（91.3%）患者接受静脉注射免疫球蛋白治疗，266 名（82.6%）患者接受皮质类固醇治疗。75 名（23.3%）患者接受了治疗性血浆置换治疗。在儿童重症监护病房停留时间较长的患者呼吸、血液或肾脏受累更频繁，D-二聚体、CK-MB 和降钙素原水平也更高。共有 16 名患者死亡，有肾脏、呼吸或神经系统受累、严重心脏损伤或休克的患者死亡率更高。未存活组的白细胞计数、乳酸和铁蛋白水平更高，需要机械通气。
结论
在 MIS-C 患者中，D-二聚体和 CK-MB 水平升高与儿童重症监护病房停留时间延长有关。未存活与白细胞计数、乳酸和铁蛋白水平升高有关。我们未能证明治疗性血浆置换治疗对死亡率有任何积极影响。
意义
MIS-C 是一种危及生命的疾病。患者需要在重症监护病房接受随访。早期发现与死亡率相关的因素可以改善结局。确定与死亡率和住院时间相关的因素将有助于临床医生进行患者管理。在 MIS-C 患者中，高 D-二聚体和 CK-MB 水平与儿童重症监护病房停留时间延长有关，白细胞计数、铁蛋白和乳酸水平升高以及机械通气与死亡率有关。我们未能证明治疗性血浆置换治疗对死亡率有任何积极影响。
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