Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
BMC Emerg Med. 2024 May 1;24(1):78. doi: 10.1186/s12873-024-00995-y.
Given the scarcity of studies analyzing the clinical predictors of pediatric septic cases that would progress to septic shock, this study aimed to determine strong predictors for pediatric emergency department (PED) patients with sepsis at risk for septic shock and mortality.
We conducted chart reviews of patients with ≥ 2 age-adjusted quick Sequential Organ Failure Assessment score (qSOFA) criteria to recognize patients with an infectious disease in two tertiary PEDs between January 1, 2021, and April 30, 2022. The age range of included patients was 1 month to 18 years. The primary outcome was development of septic shock within 48 h of PED attendance. The secondary outcome was sepsis-related 28-day mortality. Initial important variables in the PED and hemodynamics with the highest and lowest values during the first 24 h of admission were also analyzed.
Overall, 417 patients were admitted because of sepsis and met the eligibility criteria for the study. Forty-nine cases progressed to septic shock within 48 h after admission and 368 were discharged without progression. General demographics, laboratory data, and hemodynamics were analyzed by multivariate analysis. Only the minimum diastolic blood pressure/systolic blood pressure ratio (D/S ratio) during the first 24 h after admission remained as an independent predictor of progression to septic shock and 28-day mortality. The best cutoff values of the D/S ratio for predicting septic shock and 28-day mortality were 0.52 and 0.47, respectively.
The D/S ratio is a practical bedside scoring system in the PED and had good discriminative ability in predicting the progression of septic shock and in-hospital mortality in PED patients. Further validation is essential in other settings.
鉴于分析儿科败血症病例向感染性休克进展的临床预测因素的研究较少，本研究旨在确定儿科急诊（PED）中患有败血症且有感染性休克和死亡风险的患者的强预测因素。
我们对 2021 年 1 月 1 日至 2022 年 4 月 30 日期间在两家三级 PED 中符合年龄调整后快速序贯器官衰竭评估（qSOFA）评分≥2 标准的≥1 个月至 18 岁感染性疾病患者进行病历回顾。主要结局为 PED 就诊后 48 小时内发生感染性休克。次要结局为与败血症相关的 28 天死亡率。还分析了入院后前 24 小时内 PED 和血液动力学中初始重要变量的最高和最低值。
共有 417 名患者因败血症入院，符合研究纳入标准。49 例在入院后 48 小时内进展为感染性休克，368 例出院时未进展。对一般人口统计学、实验室数据和血液动力学进行了多变量分析。只有入院后前 24 小时内的最低舒张压/收缩压比值（D/S 比值）仍然是进展为感染性休克和 28 天死亡率的独立预测因素。D/S 比值预测感染性休克和 28 天死亡率的最佳临界值分别为 0.52 和 0.47。
D/S 比值是 PED 中一种实用的床边评分系统，具有良好的鉴别能力，可预测 PED 患者感染性休克的进展和院内死亡率。在其他环境中进一步验证是必要的。
