Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.
Pediatr Crit Care Med. 2023 Dec 1;24(12):e573-e583. doi: 10.1097/PCC.0000000000003312. Epub 2023 Jun 22.
To investigate whether change in functional status from pre-hospitalization baseline to hospital discharge is associated with long-term health-related quality of life (HRQL) among children surviving septic shock.
Secondary analysis of Life After Pediatric Sepsis Evaluation (LAPSE), a prospective cohort study of children with community-acquired septic shock, enrolled from January 2014 to June 2017.
Twelve U.S. academic PICUs.
Children, 1 month to 18 years, who survived to hospital discharge and had follow-up data for HRQL at 3 and/or 12 months.
None.
Functional Status Scale (FSS) was assessed around enrollment to ascertain baseline status (pre-hospitalization) and at 28 days or hospital discharge. Two measures of HRQL were utilized: children with significant development delay were measured with the Functional Status II-R (FSII-R); typically, developing children were measured with the Pediatric Quality of Life Inventory (PedsQL). Each group was analyzed separately with multivariable regression modeling to determine the association between change in FSS from baseline to day 28 and HRQL at 3 and 12 months from PICU admission. Of the original 389 LAPSE participants, 224 (58%) are included. Among children with developmental delay ( n = 88), worsened FSS was associated with lower FSII-R at 3 months from PICU admission (-2.02; 95% CI, -3.34 to -0.0.71; p = 0.003), but not 12 months. Among developmentally typical children ( n = 136), worsened FSS was associated with lower PedsQL at both 3 and 12 months. Developmentally typical children with a neurologic insult during the PICU stay had the largest decrement in PedsQL at 12 months (-14.04 mo; 95% CI, -22.15 to -5.94 mo; p < 0.001). However, worsened FSS remained associated with poor HRQL-PedsQL at 3 and 12 months, after controlling for neurologic events (both p < 0.001).
Change in FSS during hospitalization for septic shock is associated with long-term reductions in HRQL and could serve as a useful tool for identifying children at risk for this sequela.
探讨脓毒性休克患儿从入院前基线到出院时功能状态的变化是否与长期健康相关生活质量（HRQL）相关。
这是一项对儿童脓毒症后评估（LAPSE）的二次分析，该前瞻性队列研究纳入了 2014 年 1 月至 2017 年 6 月期间从社区获得性脓毒性休克中存活下来并在 3 个月和/或 12 个月时有 HRQL 随访数据的儿童。
美国 12 家儿科 PICUs。
年龄在 1 个月至 18 岁之间，存活至出院且在 3 个月和/或 12 个月时具有 HRQL 随访数据的儿童。
无。
入院时使用功能状态量表（FSS）评估功能状态，以确定基线状态（入院前）和 28 天或出院时的状态。使用两种 HRQL 测量方法：有显著发育延迟的儿童使用功能状态 II-R（FSII-R）进行测量；通常情况下，发育正常的儿童使用儿童生活质量量表（PedsQL）进行测量。使用多变量回归模型分别分析两组，以确定从基线到第 28 天的 FSS 变化与从 PICU 入院后 3 个月和 12 个月的 HRQL 之间的关联。在最初的 389 名 LAPSE 参与者中，有 224 名（58%）入选。在有发育迟缓的儿童中（n=88），FSS 恶化与 PICU 入院后 3 个月时 FSII-R 较低相关（-2.02；95%CI，-3.34 至-0.07；p=0.003），但在 12 个月时无相关性。在发育正常的儿童中（n=136），FSS 恶化与 PedsQL 在 3 个月和 12 个月时均较低相关。在 PICU 住院期间有神经损伤的发育正常的儿童在 12 个月时的 PedsQL 下降幅度最大（-14.04 mo；95%CI，-22.15 至-5.94 mo；p<0.001）。然而，在控制神经事件后，FSS 恶化仍与 HRQL-PedsQL 在 3 个月和 12 个月时较差相关（均 p<0.001）。
脓毒性休克患儿住院期间 FSS 的变化与长期 HRQL 降低相关，可作为识别此类后遗症风险患儿的有用工具。
