Lee En-Pei, Yen Chen-Wei, Hsieh Ming-Shun, Lin Jainn-Jim, Chan Oi-Wa, Su Ya-Ting, Mu Chun-Ting, Wu Han-Ping, Hsia Shao-Hsuan
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Pediatr Neonatol. 2024 May;65(3):222-228. doi: 10.1016/j.pedneo.2023.02.010. Epub 2023 Oct 20.
Septic shock is the progression of sepsis, defined as cardiovascular dysfunction during systemic infection, and it has a mortality rate of 40 %-80 %. Loss of vascular tone is an important pathophysiological feature of septic shock. Diastolic blood pressure (DBP) was reported to be associated with vascular tone. This study aimed to identify the associations of several hemodynamic indices, especially DBP, with outcome in pediatric septic shock to allow for timely interventions.
Children with persistent catecholamine-resistant shock had a pulse index continuous cardiac output (PiCCO®) system implanted for invasive hemodynamic monitoring and were enrolled in the current study. Serial cardiac index, systemic vascular resistance index (SVRI), systolic blood pressure (SBP), mean arterial pressure (MAP), and DBP were recorded during the first 24 h following PiCCO® initiation. All hemodynamic parameters associated with 28-day mortality were further analyzed using receiver operating characteristic curve analysis.
Thirty-three children with persistent catecholamine-resistant shock were enrolled. The median age was 12 years and the youngest children were 5 years old. Univariate analysis noted that SVRI, SBP, MAP, and DBP were significantly higher, and shock index was significant lower, in survivors compared with non-survivors (p < 0.05). In the multivariate analysis, only SVRI and DBP remained independent predictors of 28-day mortality. DBP had the best correlation with SVRI (r = 0.718, n = 219, p < 0.001). The area under the receiver operating characteristic curves of SVRI and DBP for predicting 28-day mortality during the first 24 h of persistent catecholamine-resistant shock were >0.75, indicating a good prediction for mortality.
DBP correlated well with SVRI and it can serve as a predictor for mortality in pediatric septic shock. Furthermore, DBP was a superior discriminator of mortality when compared with SBP and MAP. A lower DBP was an independent hemodynamic factor associated with 28-day mortality.
感染性休克是脓毒症的进展阶段，定义为全身感染期间的心血管功能障碍，其死亡率为40%-80%。血管张力丧失是感染性休克的一个重要病理生理特征。据报道，舒张压（DBP）与血管张力有关。本研究旨在确定几种血流动力学指标，尤其是DBP，与小儿感染性休克预后的关联，以便及时进行干预。
对持续性儿茶酚胺抵抗性休克患儿植入脉搏指示连续心输出量（PiCCO®）系统进行有创血流动力学监测，并纳入本研究。在启动PiCCO®后的最初24小时内记录连续的心指数、全身血管阻力指数（SVRI）、收缩压（SBP）、平均动脉压（MAP）和DBP。使用受试者工作特征曲线分析进一步分析所有与28天死亡率相关的血流动力学参数。
纳入33例持续性儿茶酚胺抵抗性休克患儿。中位年龄为12岁，最小的患儿为5岁。单因素分析指出，与非幸存者相比，幸存者的SVRI、SBP、MAP和DBP显著更高，而休克指数显著更低（p<0.05）。在多因素分析中，只有SVRI和DBP仍然是28天死亡率的独立预测因素。DBP与SVRI的相关性最佳（r=0.718，n=219，p<0.001）。在持续性儿茶酚胺抵抗性休克的最初24小时内，SVRI和DBP预测28天死亡率的受试者工作特征曲线下面积>0.75，表明对死亡率有良好的预测能力。
DBP与SVRI相关性良好，可作为小儿感染性休克死亡率的预测指标。此外，与SBP和MAP相比，DBP是死亡率的更好判别指标。较低的DBP是与28天死亡率相关的独立血流动力学因素。
