Copana-Olmos Raul, Casson-Rodriguez Nils, Diaz-Villalobos Willmer, Urquieta-Clavel Victor, Tejerina-Ortiz Mary, Mendoza-Montoya Carol, Fernandez-Vidal Maricruz, Forest-Yepez Mariel, Blanco-Espejo Danny, Rivera-Murguia Ibeth, Castro-Auza Claudia, Gamboa-Lanza Milenka, Paco-Barral Jhovana E, Choque-Osco Gustavo, Vera-Dorado Betzhi, Cuellar-Gutierrez Magbely, Sarmiento-Zurita Alan J, Carrillo-Vargas Michelle G, Ledezma-Hurtado Brisa W, Sanchez-Pinto L Nelson
Department of Pediatric Critical Care, Hospital del Niño Manuel Ascencio Villarroel, Cochabamba, Bolivia.
Division of Pediatric Intensive Care Unit, Centro Pediatrico Albina Patiño, Cochabamba, Bolivia.
Pediatr Crit Care Med. 2025 May 1;26(5):e699-e707. doi: 10.1097/PCC.0000000000003714. Epub 2025 Feb 20.
We evaluated the Phoenix criteria and the Phoenix Sepsis Score in a multicenter retrospective cohort of critically ill children with a clinical diagnosis of sepsis or septic shock in Bolivia. In addition, we aimed to assess whether management in a PICU at high altitude in the Bolivian Andes was associated with the performance of the respiratory dysfunction component in the Phoenix Sepsis Score.
Multicenter retrospective cohort study.
Fourteen PICUs in Bolivia.
Children admitted to the PICU with a clinical diagnosis of sepsis or septic shock from January 2023 to December 2023.
None.
There were 273 patients with a diagnosis of sepsis in 2023, of which 257 (94.1%) met the 2024 Phoenix criteria for sepsis, and 166 (60.8%) met the systemic inflammatory response syndrome (SIRS)-based criteria for sepsis. Among the 257 patients meeting Phoenix sepsis criteria, 86 died (33.5%). Of the patients with Phoenix-based sepsis, there were 100 of 257 (38.9%) who were SIRS-negative, and 27 of 100 died (27.0%). After correcting the oxygenation indices for altitude, 149 of 273 patients (54.6%) had a lower Phoenix respiratory score and an associated mortality more consistent with the expected mortality of the newly derived subscore. Patients at higher altitudes had higher hemoglobin levels and higher estimated oxygen carrying capacity, and these data were independently associated with lower odds of mortality after controlling for altitude-corrected Phoenix score.
In this 2023, retrospective cohort of PICU patients with sepsis in Bolivia, we have found that the majority met the 2024 Phoenix sepsis criteria, but less than two-thirds met the SIRS-based criteria for diagnosis. However, the respiratory score in the Phoenix criteria overestimated the severity of respiratory dysfunction in more than half of the cohort, likely because the score does not take account of the Andean adaptation to high altitude, with higher oxygen carrying capacity.
我们在玻利维亚对临床诊断为脓毒症或脓毒性休克的危重症儿童多中心回顾性队列中评估了凤凰标准和凤凰脓毒症评分。此外，我们旨在评估在玻利维亚安第斯山脉高海拔地区的儿科重症监护病房（PICU）进行的管理是否与凤凰脓毒症评分中呼吸功能障碍部分的表现相关。
多中心回顾性队列研究。
玻利维亚的14个PICU。
2023年1月至2023年12月因临床诊断为脓毒症或脓毒性休克而入住PICU的儿童。
无。
2023年有273例诊断为脓毒症的患者，其中257例（94.1%）符合2024年脓毒症的凤凰标准，166例（60.8%）符合基于全身炎症反应综合征（SIRS）的脓毒症标准。在符合凤凰脓毒症标准的257例患者中，86例死亡（33.5%）。在基于凤凰标准的脓毒症患者中，257例中有100例（38.9%）为SIRS阴性，其中100例中有27例死亡（27.0%）。在对海拔高度进行氧合指数校正后，273例患者中有149例（54.6%）的凤凰呼吸评分较低，且相关死亡率与新推导的子评分的预期死亡率更一致。海拔较高的患者血红蛋白水平较高，估计的氧携带能力也较高，在控制海拔校正后的凤凰评分后，这些数据与较低的死亡几率独立相关。
在2023年玻利维亚PICU脓毒症患者的回顾性队列中，我们发现大多数患者符合2024年凤凰脓毒症标准，但不到三分之二的患者符合基于SIRS的诊断标准。然而，凤凰标准中的呼吸评分高估了超过一半队列中呼吸功能障碍的严重程度，可能是因为该评分没有考虑到安第斯人群对高海拔的适应性，即较高的氧携带能力。
