Rosenzweig Andrew, Yuki Koichi
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA.
Boston University, USA.
Transl Perioper Pain Med. 2023;10(2):515-521. Epub 2023 Jun 7.
Sepsis is a syndrome of dysregulated response to infection and is associated with high morbidity and mortality. Sepsis was initially defined as a host's systemic inflammatory response syndrome (SIRS) to infection. In 2016, the importance of dysregulated response was incorporated into the definition of sepsis; adult sepsis was redefined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, with organ function being evaluated by the Sequential Organ Failure Assessment (SOFA) score (Sepsis-3 definition). However, the definition of pediatric sepsis remains the same, based on the original, SIRS-based criteria. In this study, we examined the relationship between mortality and sepsis in pediatric patients in our institution using the Sepsis-3 definition by incorporating the pediatric SOFA (pSOFA) score system, which was reported in 2017. We found that sepsis mortality was better correlated with the pSOFA score in our pediatric cohort. We also found that patients who did not have identified microbes were associated with better survival. In the future, we need to determine the relationship between mortality and Sepsis-3 definition-based pediatric sepsis worldwide to further define the utility of this new definition.
脓毒症是一种对感染反应失调的综合征，与高发病率和死亡率相关。脓毒症最初被定义为宿主对感染的全身性炎症反应综合征（SIRS）。2016年，反应失调的重要性被纳入脓毒症的定义中；成人脓毒症被重新定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍，器官功能通过序贯器官衰竭评估（SOFA）评分进行评估（脓毒症-3定义）。然而，小儿脓毒症的定义仍基于最初的基于SIRS的标准保持不变。在本研究中，我们通过纳入2017年报道的小儿SOFA（pSOFA）评分系统，使用脓毒症-3定义来研究我们机构中儿科患者死亡率与脓毒症之间的关系。我们发现，在我们的儿科队列中，脓毒症死亡率与pSOFA评分的相关性更好。我们还发现，未鉴定出微生物的患者生存率更高。未来，我们需要确定全球范围内死亡率与基于脓毒症-3定义的小儿脓毒症之间的关系，以进一步明确这一新定义的实用性。
