Liu G, Zhang C M, Li Y, Sun J Y, Cheng Y B, Chen Y P, Wang Z H, Ren H, Liu C F, Jin Y P, Chen S, Wang X M, Xu F, Xu X Z, Zhu Q J, Wang X D, Liu X H, Liu Y, Hu Y, Wang W, Ai Q, Dang H X, Gao H M, Fan C N, Qian S Y
Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhonghua Er Ke Za Zhi. 2024 Mar 2;62(3):211-217. doi: 10.3760/cma.j.cn112140-20231014-00286.
To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes. The clinical data of children with septic shock in children's PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by -test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) 7.5% (40/530), and 0.7% (5/717) 3.2% (17/530), =21.51 and 11.08, respectively; all <0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) 0.2% (1/530), =6.51, =0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) 59.2% (87/147), 17.7% (26/147) 4.1% (6/147), 15.6% (25/147) 4.1% (7/147), and 35.4% (52/147) 21.4% (32/147); =11.07, 14.02, 11.06 and 6.67, all <0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) 3 (1, 7)d, 5.01, 0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs (=2.42, 0.22, 0.25, 0.56 and 1.12, all <0.05). The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.
调查中国儿科重症监护病房（PICU）中感染性休克患儿的呼吸道病毒感染情况及其对临床结局的影响。回顾性收集了2018年1月至2019年12月期间中国10家医院儿童PICU中感染性休克患儿的临床资料。根据发病时间将其分为新冠疫情前组和新冠疫情后组，比较两组呼吸道病毒的特征和构成。匹配年龄、恶性基础疾病、细菌、真菌及其他病毒，采用1∶1倾向评分匹配法建立新数据库。根据是否感染呼吸道病毒将患儿分为呼吸道病毒组和非呼吸道病毒组；采用t检验、秩和检验和卡方检验比较两组的临床特征、诊断及治疗情况。采用logistic回归分析呼吸道病毒感染与临床结局之间的相关性。本研究共纳入1247例感染性休克患儿，其中男性748例；年龄为37（11，105）个月。新冠疫情前组和后组分别有530例和717例感染性休克患儿；呼吸道病毒阳性率分别为14.9%（79例）和9.8%（70例）；感染性休克的季节分布在秋季分别为28.9%（153/530）和25.9%（185/717），冬季分别为30.3%（161/530）和28.3%（203/717），相应呼吸道病毒阳性率在秋季分别为19.6%（30/153）和15.7%（29/185），冬季分别为21.1%（34/161）和15.3%（31/203）。新冠疫情后组流感病毒和腺病毒的阳性率低于新冠疫情前组（分别为2.1%（15/717）对7.5%（40/530），以及0.7%（5/717）对3.2%（17/530），χ²分别为21.51和11.08；均P<0.05）。鼻病毒高于新冠疫情前组（1.7%（12/717）对0.2%（1/530），χ²=6.51，P=0.011）。倾向评分匹配后，呼吸道病毒组和非呼吸道病毒组各有147例。呼吸道病毒组的呼吸衰竭发生率、急性呼吸窘迫发生率、弥散性凝血功能障碍发生率及免疫球蛋白使用率均高于非呼吸道病毒组（分别为77.6%（114/147）对59.2%（87/147），17.7%（26/147）对4.1%（6/147），15.6%（25/147）对4.1%（7/147），以及35.4%（52/147）对21.4%（32/147）；χ²分别为11.07、14.02、11.06和6.67，均P<0.05）；且前者在PICU的住院时间长于后者（7（3，16）天对3（1，7）天，t=5.01，P=0.001）。单因素logistic回归分析显示，呼吸道病毒感染与呼吸衰竭、弥散性凝血功能障碍、机械通气的使用、免疫球蛋白及抗呼吸道病毒药物的使用相关（β分别为2.42、0.22、0.25、0.56和1.12，均P<0.05）。新冠疫情前后感染性休克患儿呼吸道病毒感染的构成不同。呼吸道病毒感染与感染性休克患儿的器官功能障碍相关。通过呼吸道防护减少呼吸道病毒感染可能改善这些患儿的临床结局。
