Impact of Rapid Leukodepletion on the Outcome of Severe Clinical Pertussis in Young Infants
Impact of Rapid Leukodepletion on the Outcome of Severe Clinical Pertussis in Young Infants
复制标题
DOI：
10.1542/peds.2009-2860
复制
发表时间：
2010-10-01
期刊：
影响因子：
8
通讯作者：
Peters, Mark J.
中科院分区：
文献类型：
--
作者：
Rowlands, Helen E.;Goldman, Allan P.;Peters, Mark J.
目的：百日咳杆菌是一种常见的、认识不足的、疫苗可预防的危重病原因，在世界范围内婴儿死亡率很高。严重病例的患者表现为极度白细胞增多，并出现难治性低氧血症和肺动脉高压，对最大程度的重症监护无反应。这可能反映了白色血细胞（WBC）计数升高引起的高粘滞综合征。病例报告表明，通过换血减少WBC计数可改善结局。我们的目标是量化可能的好处积极leukodeletures.METHODS：我们，作为一个区域PICU和体外膜肺氧合转诊中心，在2005年1月通过了积极leukodeletures. METHODS的战略。该策略对所有重症B型百日咳婴儿的粗和病例混合调整后生存率的影响与2001年1月至2004年12月的对照组和Extracorporal Life Support Organisation registry data.RESULTS：2001年至2009年，19名婴儿（7名[37%]男孩）接受了B型百日咳的重症监护。两个时间段的入院WBC计数相当：2001-2004年（平均值：52 000/mu L）和2005-2009年（平均值：75 000/mu L）。2001-2004年，9例患者中有5例（55%）在ICU中存活。2005年至2009年，10名患者中有9名（90%）存活。当考虑到年龄、WBC计数和体外膜肺氧合转诊的病例组合调整时，2001-2004年的预测生存率（4.4 [49%]/9.0）与观察到的死亡率（4.0 [44%]/9.0）相当。在2005年至2009年期间，观察到的死亡率（1.0 [10%]/10.0）显著优于预测值（4.7 [47%]/10.0）。结论：在患有B型百日咳和白细胞增多症的危重婴儿中应考虑白细胞耗竭。儿科2010;126：e816-e827
OBJECTIVES: Bordetella pertussis is a common, underrecognized, and vaccine-preventable cause of critical illness with a high mortality in infants worldwide. Patients with severe cases present with extreme leukocytosis and develop refractory hypoxemia and pulmonary hypertension that is unresponsive to maximal intensive care. This may reflect a hyperviscosity syndrome from the raised white blood cell (WBC) count. Case reports suggest improved outcomes with exchange transfusion to reduce the WBC count. Our objective was to quantify possible benefits of aggressive leukodepletion.METHODS: We, as a regional PICU and extracorporeal membrane oxygenation referral center, adopted a strategy of aggressive leukodepletion in January 2005. The impact of this strategy on crude and case mix-adjusted survival of all infants who were critically ill with B pertussis were compared with control subjects from January 2001 to December 2004 and Extracorporeal Life Support Organisation registry data.RESULTS: Nineteen infants (7 [37%] boys) received intensive care for B pertussis from 2001 to 2009. Admission WBC counts were equivalent in 2 time periods: 2001-2004 (mean: 52 000/mu L) and 2005-2009 (mean: 75 000/mu L). In 2001-2004, 5 (55%) of 9 patients survived the ICU. Between 2005 and 2009, 9 (90%) of 10 patients survived. When case-mix adjustment for age, WBC count, and extracorporeal membrane oxygenation referral were considered, the 2001-2004 predicted survival (4.4 [49%] of 9.0) was equivalent to the observed mortality (4.0 [44%] of 9.0). Between 2005 and 2009, observed mortality (1.0 [10%] of 10.0) was significantly better than predicted (4.7 [47%] of 10.0).CONCLUSIONS: Leukodepletion should be considered in critically ill infants with B pertussis and leukocytosis. Pediatrics 2010;126: e816-e827