Prout Andrew, Banks Russell K, Reeder Ron W, Zimmerman Jerry J, Meert Kathleen L
Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan, and Central Michigan University College of Medicine, Mt. Pleasant, Michigan, United States.
Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States.
J Pediatr Intensive Care. 2022 Jan 18;13(3):242-252. doi: 10.1055/s-0041-1741402. eCollection 2024 Sep.
Preexisting neurologic disability is common among children with septic shock. Life After Pediatric Sepsis Evaluation (LAPSE) was a multicenter cohort study that evaluated health-related quality of life (HRQL) in children with community-acquired septic shock. In this secondary analysis of LAPSE, we described the burden, trajectory, and risk factors for reduced HRQL in children with preexisting neurologic disability. Children (1 month-18 years) with community-acquired septic shock were evaluated for HRQL at baseline (reflecting prehospitalization status), day 7 and 28, and month 3, 6, and 12 following admission using the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale. HRQL was expressed as a percentage of baseline scores. Of 365 evaluable children, 133 (36%) had preexisting neurologic disability. Neurologically disabled children had less decline in HRQL at day 7 (median -15% [interquartile range IQR: -38, 8] vs. -22% [-51, -3], = 0.005) and day 28 (4% [-16, 22] vs. -11% [-37, 7], < 0.001) than those without neurologic disability, and there was no difference in the extent of decline at month 3 ( = 0.241). Using multivariable modeling, higher baseline HRQL (odds ratio [OR] = 1.04 [95% confidence interval [CI]: 1.00, 1.08], = 0.027) and acute renal dysfunction (OR = 1.08 [1.02, 1.16], = 0.007) were associated with HRQL less than 90% of baseline at month 3 in neurologically disabled children who survived. Children with preexisting neurologic disability recover to baseline HRQL after septic shock sooner than those without neurologic disability. Higher baseline HRQL and acute renal dysfunction are risk factors for reduced HRQL in neurologically disabled children who survive sepsis.
既往存在神经功能障碍在脓毒性休克患儿中很常见。儿童脓毒症评估后的生活（LAPSE）是一项多中心队列研究，评估社区获得性脓毒性休克患儿的健康相关生活质量（HRQL）。在这项LAPSE的二次分析中，我们描述了既往存在神经功能障碍患儿HRQL降低的负担、轨迹和危险因素。使用儿童生活质量量表或斯坦 - 杰索普功能状态量表，对社区获得性脓毒性休克患儿（1个月至18岁）在基线（反映住院前状态）、入院后第7天和第28天以及第3、6和12个月时的HRQL进行评估。HRQL以基线分数的百分比表示。在365名可评估儿童中，133名（36%）有既往神经功能障碍。与无神经功能障碍的儿童相比，有神经功能障碍的儿童在第7天（中位数 -15% [四分位间距IQR：-38, 8] 对 -22% [-51, -3]，P = 0.005）和第28天（4% [-16, 22] 对 -11% [-37, 7]，P < 0.001）时HRQL下降较少，且在第3个月时下降程度无差异（P = 0.241）。使用多变量模型，较高的基线HRQL（比值比[OR] = 1.04 [95%置信区间[CI]：1.00, 1.08]，P = 0.027）和急性肾功能障碍（OR = 1.08 [1.02, 1.16]，P = 0.007）与存活的有神经功能障碍患儿在第3个月时HRQL低于基线的90%相关。既往存在神经功能障碍的儿童在脓毒性休克后恢复到基线HRQL的时间比无神经功能障碍的儿童更快。较高的基线HRQL和急性肾功能障碍是存活的脓毒症神经功能障碍患儿HRQL降低的危险因素。
