Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN.
Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN.
Chest. 2023 Nov;164(5):1204-1215. doi: 10.1016/j.chest.2023.05.002. Epub 2023 May 8.
Delayed mortality in sepsis often is linked to a lack of resolution in the inflammatory cascade termed persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Limited research exists on PICS in pediatric patients with sepsis.
What is the prevalence of pediatric PICS (pPICS) in patients who died of sepsis-related causes and what associated pathogen profiles and comorbidities did they have compared with those patients without pPICS who died from sepsis?
A retrospective study of a single institution using a de-identified database from 1997 through 2020 for all patients aged 21 years or younger who died of culture-positive sepsis from a known source and who had laboratory data available were evaluated for the presence of pPICS.
Among records extracted from the institutional database, 557 patients had culture-positive sepsis, with 262 patients having pPICS (47%). Patients with pPICS were more likely to have underlying hematologic or oncologic disease or cardiac disease. In addition, patients who had pPICS showed increased odds of associated fungal infection compared with those patients who did not (OR, 2.69; 95% CI, 1.59-4.61; P < .001). When assessing laboratory criteria, having a sustained absolute lymphocyte count of < 1.0 × 10/μL was most closely associated with having pPICS compared with other laboratory parameters. Finally, the results of multivariate logistic regression analysis indicated that patients with pPICS were more common in the cardiac ICU, as opposed to the PICU (OR, 3.43; CI, 1.57-7.64; P = .002).
Pediatric patients who died of a sepsis-related cause have a pPICS phenotype nearly one-half of the time. These patients are more likely to be in the cardiac ICU than the pediatric ICU and have associated fungal infections. Special attention should be directed toward this population in future research.
脓毒症导致的迟发性死亡通常与炎症级联反应中缺乏消退有关，这种反应被称为持续炎症、免疫抑制和分解代谢综合征（PICS）。儿科脓毒症患者的 PICS 相关研究有限。
死于脓毒症相关原因的儿科患者（pPICS）的患病率是多少？与没有 pPICS 但死于脓毒症的患者相比，他们的病原体特征和合并症有哪些？
这是一项单中心回顾性研究，使用 1997 年至 2020 年期间来自一个机构的匿名数据库，评估所有年龄在 21 岁或以下、有明确来源的培养阳性脓毒症且有实验室数据的患者是否存在 pPICS。
从机构数据库中提取记录后，共 557 名患者患有培养阳性脓毒症，其中 262 名患者（47%）患有 pPICS。患有 pPICS 的患者更有可能患有血液系统或肿瘤疾病或心脏疾病。此外，与没有 pPICS 的患者相比，患有 pPICS 的患者发生合并真菌感染的几率增加（OR，2.69；95%CI，1.59-4.61；P<0.001）。在评估实验室标准时，与其他实验室参数相比，持续的绝对淋巴细胞计数<1.0×10/μL 与患有 pPICS 最密切相关。最后，多变量逻辑回归分析的结果表明，患有 pPICS 的患者更常见于心脏 ICU，而不是儿科 ICU（OR，3.43；CI，1.57-7.64；P=0.002）。
近一半死于脓毒症相关原因的儿科患者存在 PICS 表型。这些患者更有可能在心脏 ICU 而不是儿科 ICU，并且有合并真菌感染。在未来的研究中，应特别关注这一人群。
