Yang Lin, Zang Na, Liu Cong, Yang Ying, Pu Kai Bing, Tan Li Ping, Liu En Mei
Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, China.
National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China.
Front Pediatr. 2025 May 2;13:1561044. doi: 10.3389/fped.2025.1561044. eCollection 2025.
This study aimed to examine the clinical characteristics and risk factors associated with the development of chronic critical illness (CCI) in children with sepsis.
A retrospective analysis was conducted on children diagnosed with sepsis and admitted to the Pediatric Intensive Care Unit (PICU) at Chongqing Medical University Affiliated Children's Hospital between January 2015 and December 2022. Patients were categorized into two groups based on clinical outcomes: CCI group, defined by an ICU stay ≥14 days with persistent organ dysfunction, and non-CCI group, including patients with rapid recovery or early death. Data on baseline demographics, clinical characteristics, and diagnostic and therapeutic differences were collected and analyzed.
Among 1,326 children with sepsis, 244 were classified in the CCI group (135 males, 109 females) and 1,082 were classified in the non-CCI group (651 males, 431 females), including 163 cases in the early death group and 919 cases in the rapid recovery group. No significant differences were observed between the groups in terms of sex, age distribution, or prevalence of septic shock. Respiratory and gastrointestinal infections were the predominant sources of infection in both groups. Compared to the non-CCI group, the CCI group exhibited significantly higher weights, pediatric sequential organ failure assessment (pSOFA) scores, rates of underlying respiratory diseases, trauma, surgical interventions, mechanical ventilation duration, ICU stay, total hospital stay, and secondary infection rates. Multivariate logistic regression identified pSOFA score, underlying respiratory diseases, trauma, prolonged mechanical ventilation, surgical interventions, and secondary infections as independent risk factors for the development of CCI in children with sepsis. Based on ROC analysis, the AUC of the established CCI prediction model was 0.902 (95% CI: 0.873-0.928). Secondary infections were also a prominent clinical feature of CCI cases.
CCI in pediatric sepsis is associated with underlying respiratory diseases, trauma, elevated pSOFA scores, surgical procedures, prolonged mechanical ventilation and secondary infections. These factors contribute to extended hospital stays, elevated secondary infection rates, and poor clinical outcomes. The persistence of pro-inflammatory mediators and subsequent immunosuppression may underlie the development of CCI in this population.
本研究旨在探讨脓毒症患儿发生慢性危重病（CCI）的临床特征及危险因素。
对2015年1月至2022年12月期间在重庆医科大学附属儿童医院儿科重症监护病房（PICU）确诊为脓毒症的患儿进行回顾性分析。根据临床结局将患者分为两组：CCI组，定义为入住ICU≥14天且存在持续性器官功能障碍；非CCI组，包括恢复快或早期死亡的患者。收集并分析基线人口统计学、临床特征以及诊断和治疗差异的数据。
在1326例脓毒症患儿中，244例被归类为CCI组（男135例，女109例），1082例被归类为非CCI组（男651例，女431例），其中早期死亡组163例，快速恢复组919例。两组在性别、年龄分布或脓毒性休克患病率方面未观察到显著差异。呼吸和胃肠道感染是两组中主要的感染源。与非CCI组相比，CCI组的体重、小儿序贯器官衰竭评估（pSOFA）评分、潜在呼吸系统疾病发生率、创伤、手术干预、机械通气时间、ICU住院时间、总住院时间及继发感染率显著更高。多因素逻辑回归确定pSOFA评分、潜在呼吸系统疾病、创伤、机械通气时间延长、手术干预及继发感染是脓毒症患儿发生CCI的独立危险因素。基于ROC分析，所建立的CCI预测模型的AUC为0.902（95%CI：0.873 - 0.928）。继发感染也是CCI病例的一个突出临床特征。
小儿脓毒症中的CCI与潜在呼吸系统疾病、创伤、pSOFA评分升高、手术、机械通气时间延长及继发感染有关。这些因素导致住院时间延长、继发感染率升高及临床结局不佳。促炎介质的持续存在及随后的免疫抑制可能是该人群发生CCI的基础。
