Multiple Organ Dysfunction Interactions in Critically Ill Children.
Multiple Organ Dysfunction Interactions in Critically Ill Children.
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DOI：
10.3389/fped.2022.874282
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发表时间：
2022
影响因子：
2.6
通讯作者：
Sanchez-Pinto, L. Nelson
中科院分区：
文献类型：
--
作者：
Badke, Colleen M.;Mayampurath, Anoop;Sanchez-Pinto, L. Nelson
多器官功能障碍（MOD）是危重儿童发病和死亡的常见途径。定义器官功能障碍具有挑战性，因为我们缺乏对复杂病理学的完整了解。目前的儿科器官功能障碍标准为每个器官系统分配相同的诊断价值（相同的“权重”）。虽然每个单独的器官功能障碍都会对结果产生影响，但多个衰竭器官之间可能存在复杂的相互作用，而这些相互作用并不是简单的相加。确定器官系统功能障碍的某些组合是否与危重儿童发病或死亡的较高风险存在显着的相互作用。我们对 2010 年和 2018 年两个大型学术医疗中心的危重儿童进行了一项回顾性观察队列研究。根据儿科器官功能障碍信息更新指令 (PODIUM) 标准，如果患者在 PICU 入院第 3 天时出现至少两种器官功能障碍，则将其纳入研究。死亡率被描述为死亡的绝对人数和死亡率。在逻辑回归模型中，以交互作用项作为自变量，以死亡率或持续性 MOD 作为因变量，对两种儿科器官功能障碍的组合进行分析。总体而言，7,897 名患者符合纳入标准，其中 446 名患者 (5.6%) 死亡。与最高绝对死亡人数显着相关的器官功能障碍相互作用是心血管+内分泌、心血管+神经系统和心血管+呼吸系统。此外，与最高死亡率相关的相互作用是肝脏+心血管、呼吸+血液和呼吸+肾脏。在持续性 MOD 患者中，最常见且具有显着交互作用的器官功能障碍是神经系统 + 呼吸系统、血液系统 + 免疫系统以及内分泌 + 呼吸系统。使用分类和回归树 (CART) 的进一步分析表明，不存在呼吸和肝功能障碍与死亡率最低的可能性相关。器官功能障碍的某些组合与持续性 MOD 或死亡的较高风险相关。值得注意的是，三种最常见的器官功能障碍相互作用与我们队列中 75% 的死亡率相关。伴有这些器官功能障碍组合的 MOD 危重儿童值得进一步研究。
Multiple organ dysfunction (MOD) is a common pathway to morbidity and death in critically ill children. Defining organ dysfunction is challenging, as we lack a complete understanding of the complex pathobiology. Current pediatric organ dysfunction criteria assign the same diagnostic value—the same “weight”— to each organ system. While each organ dysfunction in isolation contributes to the outcome, there are likely complex interactions between multiple failing organs that are not simply additive. Determine whether certain combinations of organ system dysfunctions have a significant interaction associated with higher risk of morbidity or mortality in critically ill children. We conducted a retrospective observational cohort study of critically ill children at two large academic medical centers from 2010 and 2018. Patients were included in the study if they had at least two organ dysfunctions by day 3 of PICU admission based on the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) criteria. Mortality was described as absolute number of deaths and mortality rate. Combinations of two pediatric organ dysfunctions were analyzed with interaction terms as independent variables and mortality or persistent MOD as the dependent variable in logistic regression models. Overall, 7,897 patients met inclusion criteria and 446 patients (5.6%) died. The organ dysfunction interactions that were significantly associated with the highest absolute number of deaths were cardiovascular + endocrinologic, cardiovascular + neurologic, and cardiovascular + respiratory. Additionally, the interactions associated with the highest mortality rates were liver + cardiovascular, respiratory + hematologic, and respiratory + renal. Among patients with persistent MOD, the most common organ dysfunctions with significant interaction terms were neurologic + respiratory, hematologic + immunologic, and endocrinologic + respiratory. Further analysis using classification and regression trees (CART) demonstrated that the absence of respiratory and liver dysfunction was associated with the lowest likelihood of mortality. Certain combinations of organ dysfunctions are associated with a higher risk of persistent MOD or death. Notably, the three most common organ dysfunction interactions were associated with 75% of the mortality in our cohort. Critically ill children with MOD presenting with these combinations of organ dysfunctions warrant further study.
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DOI：
10.1186/cc11652
发表时间：
2012-10-01
期刊：
Critical care (London, England)
影响因子：
--
作者：
Wong HR;Salisbury S;Xiao Q;Cvijanovich NZ;Hall M;Allen GL;Thomas NJ;Freishtat RJ;Anas N;Meyer K;Checchia PA;Lin R;Shanley TP;Bigham MT;Sen A;Nowak J;Quasney M;Henricksen JW;Chopra A;Banschbach S;Beckman E;Harmon K;Lahni P;Lindsell CJ
通讯作者：
Lindsell CJ
DOI：
10.1097/pcc.0b013e3181a64be1
发表时间：
2009-09
期刊：
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
影响因子：
--
作者：
Typpo KV;Petersen NJ;Hallman DM;Markovitz BP;Mariscalco MM
通讯作者：
Mariscalco MM
影响因子：
8.8
作者：
Shakoory B;Carcillo JA;Chatham WW;Amdur RL;Zhao H;Dinarello CA;Cron RQ;Opal SM
通讯作者：
Opal SM
DOI：
10.1097/pcc.0000000000000978
发表时间：
2017-01
期刊：
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
影响因子：
--
作者：
Lin JC;Spinella PC;Fitzgerald JC;Tucci M;Bush JL;Nadkarni VM;Thomas NJ;Weiss SL;Sepsis Prevalence, Outcomes, and Therapy Study Investigators
通讯作者：
Sepsis Prevalence, Outcomes, and Therapy Study Investigators
影响因子：
8
作者：
Bembea, Melania M.;Agus, Michael;Akcan-Arikan, Ayse;Alexander, Peta;Basu, Rajit;Bennett, Tellen D.;Bohn, Desmond;Brandao, Leonardo R.;Brown, Ann-Marie;Carcillo, Joseph A.;Checchia, Paul;Cholette, Jill;Cheifetz, Ira M.;Cornell, Timothy;Doctor, Allan;Eckerle, Michelle;Erickson, Simon;Farris, Reid W. D.;Faustino, E. Vincent S.;Fitzgerald, Julie C.;Fuhrman, Dana Y.;Giuliano, John S., Jr.;Guilliams, Kristin;Gaies, Michael;Gorga, Stephen M.;Hall, Mark;Hanson, Sheila J.;Hartman, Mary;Hassinger, Amanda B.;Irving, Sharon Y.;Jeffries, Howard;Jouvet, Philippe;Kannan, Sujatha;Karam, Oliver;Khemani, Robinder G.;Kissoon, Niranjan;Lacroix, Jacques;Laussen, Peter;Leclerc, Francis;Lee, Jan Hau;Leteurtre, Stephane;Lobner, Katie;McKiernan, Patrick J.;Menon, Kusum;Monagle, Paul;Muszynski, Jennifer A.;Odetola, Folafoluwa;Parker, Robert;Pathan, Nazima;Pierce, Richard W.;Pineda, Jose;Prince, Jose M.;Robinson, Karen A.;Rowan, Courtney M.;Ryerson, Lindsay M.;Sanchez-Pinto, L. Nelson;Schlapbach, Luregn J.;Selewski, David T.;Shekerdemian, Lara S.;Simon, Dennis;Smith, Lincoln S.;Squires, James E.;Squires, Robert H.;Sutherland, Scott M.;Ouellette, Yves;Spaeder, Michael C.;Srinivasan, Vijay;Steiner, Marie E.;Tasker, Robert C.;Thiagarajan, Ravi;Thomas, Neal;Tissieres, Pierre;Traube, Chani;Tucci, Marisa;Typpo, Katri, V;Wainwright, Mark S.;Ward, Shan L.;Watson, R. Scott;Weiss, Scott;Whitney, Jane;Willson, Doug;Wynn, James L.;Yehya, Nadir;Zimmerman, Jerry J.
通讯作者：
Zimmerman, Jerry J.