Khowaja Rahil, Karimi Fazila
School of Medicine, Swansea University, Swansea, United Kingdom *Email:
School of Public Health, SZABIST University, Karachi, Pakistan.
Qatar Med J. 2024 Jul 29;2024(3):32. doi: 10.5339/qmj.2024.32. eCollection 2024.
Comparatively, culture-negative septic shock or septic shock (CNSS) is frequently observed among pediatric patients, contrasting with the more distinct clinical profile and prognosis of post-surgical septic shock (CPSS). However, limited data are available on the outcomes of CNSS in comparison to CPSS in pediatric patients. This study seeks to conduct a systematic review and meta-analysis of existing literature to comprehensively compare outcomes between CNSS and CPSS in pediatric patients.
Electronic databases, such as PubMed, CINAHIL, and EMBASE, were systematically searched up to January 15, 2024, using predefined terms. We included all studies that compared outcomes between CPSS and CNSS in pediatric patients. The primary outcome evaluated in this study was all-cause mortality. Secondary outcomes included length of hospitalization, length of intensive care unit (ICU) stay, and duration of mechanical ventilation (all measured in days).
Among the initially identified 1328 articles, six studies involving 2511 pediatric patients met the inclusion criteria and were part of this meta-analysis study. The pooled analysis revealed no significant differences in all-cause mortality (odds ratio: 1.26, 95% confidence interval (CI): 0.93 to 1.70, = 0.14), length of ICU stay (mean difference (MD): 0.18, 95% CI: -0.33 to 0.68, = 0.50), and duration of mechanical ventilation (MD: -0.74, 95% CI: -2.46 to 0.98, -value = 0.40) between CPSS and CNSS. However, the length of hospital stay was longer in CPSS compared to CNSS (MD: 7.38, 95% CI: 5.50 to 9.27, < 0.0001).
Approximately 26.56% of pediatric septic cases were culture-positive. There were no statistically significant differences in mortality, ICU stay, and duration of mechanical ventilation between CPSS and CNSS. However, hospital stay was prolonged by more than 7 days in culture-positive cases. Further multicenter studies are warranted to validate these findings and explore additional presentation characteristics.
相比之下，在儿科患者中经常观察到血培养阴性的感染性休克或感染性休克（CNSS），这与外科手术后感染性休克（CPSS）更为明显的临床特征和预后形成对比。然而，与儿科患者的CPSS相比，关于CNSS结局的数据有限。本研究旨在对现有文献进行系统综述和荟萃分析，以全面比较儿科患者中CNSS和CPSS的结局。
截至2024年1月15日，使用预定义术语对电子数据库，如PubMed、CINAHIL和EMBASE进行系统检索。我们纳入了所有比较儿科患者CPSS和CNSS结局的研究。本研究评估的主要结局是全因死亡率。次要结局包括住院时间、重症监护病房（ICU）住院时间和机械通气时间（均以天为单位）。
在最初识别的1328篇文章中，六项涉及2511名儿科患者的研究符合纳入标准，是本荟萃分析研究的一部分。汇总分析显示，CPSS和CNSS在全因死亡率（优势比：1.26，95%置信区间（CI）：0.93至1.70，P = 0.14）、ICU住院时间（平均差（MD）：0.18，95%CI：-0.33至0.68，P = 0.50）和机械通气时间（MD：-0.74，95%CI：-2.46至0.98，P值 = 0.40）方面无显著差异。然而，与CNSS相比，CPSS的住院时间更长（MD：7.38，95%CI：5.50至9.27，P < 0.0001）。
约26.56%的儿科感染病例血培养呈阳性。CPSS和CNSS在死亡率、ICU住院时间和机械通气时间方面无统计学显著差异。然而，血培养阳性病例的住院时间延长超过7天。需要进一步的多中心研究来验证这些发现并探索其他表现特征。
