Luan Vo Thanh, Tien Vo Thi-Hong, Phuong Ngo Thi-Mai, Viet Do Chau, Tung Trinh Huu, Thanh Nguyen Tat
Department of Infectious Diseases, Children's Hospital 2, Ho Chi Minh City, Vietnam.
Department of Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
PLoS Negl Trop Dis. 2025 Jan 10;19(1):e0012786. doi: 10.1371/journal.pntd.0012786. eCollection 2025 Jan.
Severe respiratory distress and acute kidney injury (AKI) are key factors leading to poor outcomes in patients with dengue shock syndrome (DSS). There is still limited data on how much resuscitated fluid and the specific ratios of intravenous fluid types contribute to the development of severe respiratory distress necessitating mechanical ventilation (MV) and AKI in children with DSS.
METHODOLOGY/PRINCIPAL FINDINGS: This retrospective study was conducted at a tertiary pediatric hospital in Vietnam between 2013 and 2022. The primary outcomes were the need for MV and renal function within 48 h post-admission. A predictive model for MV was developed based on covariates from the first 24 h of PICU admission. Changes in renal function within 48 h were analyzed using a linear mixed-effects model. A total of 1,278 DSS children with complete clinical and fluid data were included. The predictive performance of MV based on the total intravenous fluid volume administered yielded an AUC of 0.871 (95% CI, 0.836-0.905), while the colloid-to-crystalloid ratio showed an AUC of 0.781 (95% CI, 0.743-0.819) (both P < 0.001). The optimal cut-off point of the cumulative fluid infusion was 181 mL/kg, whereas that of the colloid-to-crystalloid ratio was 1.6. Multivariable analysis identified female patients, severe bleeding, severe transaminitis, excessive fluid resuscitation, and a higher proportion of colloid solutions in the first 24 h as significant predictors of MV in DSS patients. The predictive model for MV demonstrated high accuracy, with a C-statistic of 89%, strong calibration, and low Brier score (0.04). Importantly, a more pronounced decline in glomerular filtration rate was observed in DSS patients who required MV than in those who did not.
CONCLUSIONS/SIGNIFICANCE: This study provides insights into optimizing fluid management protocols, highlighting the importance of monitoring fluid volume and the colloid-to-crystalloid ratio during early resuscitation to improve the clinical outcomes of DSS patients.
严重呼吸窘迫和急性肾损伤（AKI）是导致登革热休克综合征（DSS）患者预后不良的关键因素。关于复苏液体量以及静脉输液类型的具体比例对DSS患儿发生需要机械通气（MV）的严重呼吸窘迫和AKI的影响，目前数据仍然有限。
方法/主要发现：本回顾性研究于2013年至2022年在越南一家三级儿科医院进行。主要结局是入院后48小时内对MV的需求和肾功能。基于PICU入院后前24小时的协变量建立了MV的预测模型。使用线性混合效应模型分析48小时内肾功能的变化。共纳入1278例有完整临床和液体数据的DSS患儿。基于总静脉输液量的MV预测性能的AUC为0.871（95%CI，0.836 - 0.905），而胶体与晶体比例的AUC为0.781（95%CI，0.743 - 0.819）（均P < 0.001）。累积液体输注的最佳截断点为181 mL/kg，而胶体与晶体比例的最佳截断点为1.6。多变量分析确定女性患者、严重出血、严重转氨酶升高、液体复苏过度以及入院后前24小时胶体溶液比例较高是DSS患者MV的显著预测因素。MV预测模型显示出高准确性，C统计量为89%，校准良好，Brier评分低（0.04）。重要的是，与不需要MV的DSS患者相比，需要MV的患者肾小球滤过率下降更为明显。
结论/意义：本研究为优化液体管理方案提供了见解，强调了在早期复苏期间监测液体量和胶体与晶体比例对改善DSS患者临床结局的重要性。
