363
363
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第363章
DOI：
10.1097/01.ccm.0000551117.25415.ff
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发表时间：
2019
影响因子：
8.8
通讯作者：
J. Coss
中科院分区：
文献类型：
--
作者：
A. Marroquín;J. Silva;Y. Desai;K. Schmucker;P. Hong;E. Villarreal;L. Shekerdemian;J. Coss
方法：回顾性研究PICU收治儿童（1/16-6/16）；由世卫组织和美国疾病控制与预防中心通过年龄体重（WFA：体重不足）、年龄身高（HFA：发育迟缓）和身高体重（WFH：消瘦）、z评分评估营养状况。如果z得分分别为<-1和<-2，则定义为轻度和中度严重营养不良。收集患儿住院和PICU住院时间（LOS）、死亡风险（ROM）（儿童死亡率指数2 (PIM2)），并计算患儿入院和出院时的POPC和PCPC。结果：共纳入1057例患儿（男/女：582/475），中位年龄5.4岁（IQR 25 ~ 75: 1.2 ~ 13）。PICU和医院LOS分别为2（1-5）天和8（4-17）天；Pim2 ROM(%) 1.12（1-4）。体重不足、发育迟缓和消瘦的患病率分别为32%、43%和24%；并与入院时PCPC状态异常相关（n= 362, 34%），比值比OR (95% CI)；分别为2.67（2-4）、3.14（2-4）、1.13 (1-2)；入院时POPC异常（n= 759, 72%）， OR分别为3.0（2-4）、3.52（3-5）、1.01（1-1.5）。入院时消瘦与出院时PCPC较差相关，1.77(1.2-2.7)，但与POPC 1.05（0.8-1.4）无关。PCPC加重患儿出院时的医院和PICU LOS分别为14（6-33）比9 (4-19)(p< 005), 4.6（2-11）比1.8 (1-4)(p< 0.0001)；和更差的POPC vs无变化，分别为10 (4-19)vs 9 (4-21)（NS）和2.5 (1-7)vs 1.8 (1-4)（p< 0.0001）。入院时PCPC状态异常与机械通气需求和较高的ROM有关；2.15 (1.7-2.8), 1.56 (1.2-2.1)；未发现与异常的POPC状态相关。PICU死亡率为3.9%，与入院PCPC或POPC无关。结论：PCPC和POPC异常在危重患儿中较为常见，与呼吸机支持需求和死亡风险增高有关。功能状况恶化与营养不良、住院时间和PICU住院时间有关
Methods: Retrospective study of children admitted to PICU (1/16-6/16); nutritional status assessed by weight for age (WFA: underweight), height for age (HFA: stunting), and weight for height (WFH: wasting), Z-score by WHO and CDC. Malnutrition defined as mild, and moderate-severe if z-scores were<-1,<-2, respectively. Hospital and PICU length of stay (LOS), risk of mortality (ROM) by Pediatric Index of Mortality 2 (PIM2), were collected and POPC and PCPC were calculated on admission and discharge.Results: A total of 1057 children (Male/Female: 582/475), median age 5.4 yrs (IQR 25th-75th: 1.2–13), were included. The PICU and hospital LOS was 2 (1–5) and 8 (4–17) days; PIM2 ROM (%) 1.12 (1–4). The prevalence of underweight, stunting, and wasting was 32%, 43%, and 24%; and was associated with abnormal PCPC status on admission (n= 362, 34%), Odds Ratio OR (95% CI); 2.67 (2–4), 3.14 (2–4), and 1.13 (1–2), respectively; and abnormal POPC status on admission (n= 759, 72%), OR 3.0 (2–4), 3.52 (3–5), and 1.01 (1–1.5), respectively. Wasting on admission was associated with worse PCPC on discharge, 1.77 (1.2–2.7) but not with POPC 1.05 (0.8–1.4). Hospital and PICU LOS in children with worse PCPC on discharge vs. no change were 14 (6–33) vs. 9 (4–19)(p< 005), and 4.6 (2–11) vs. 1.8 (1–4)(p< 0.0001) respectively; and worse POPC vs. no change of 10 (4–19) vs. 9 (4–21)(NS), and 2.5 (1–7) vs. 1.8 (1–4)(p< 0.0001), respectively. Abnormal PCPC status on admission was associated with need of mechanical ventilation and higher ROM; 2.15 (1.7–2.8), 1.56 (1.2–2.1), respectively; no association was found with abnormal POPC status. PICU mortality was 3.9% and was not associated with admission PCPC or POPC.Conclusions: Abnormal status by PCPC and POPC were common in critically ill children and were associated with need of ventilator support and higher risk of mortality. There was an association between worse functional status and malnutrition, hospital and PICU length of stay