Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study.
Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study.
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DOI：
10.1371/journal.pone.0139966
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Ahmed T
中科院分区：
文献类型：
--
作者：
Chisti MJ;Salam MA;Bardhan PK;Faruque AS;Shahid AS;Shahunja KM;Das SK;Hossain MI;Ahmed T
在发展中国家，目前还没有关于严重急性营养不良（SAM）儿童肺炎严重脓毒症的预测因素和液体复苏对此类儿童的影响的公开报道。因此，我们的目的是确定严重脓毒症的预测因素，并评估液体复苏的结果，这样的孩子。在这项回顾性病例对照研究中，2011年4月至2012年7月入住孟加拉国国际腹泻病研究中心达卡医院重症监护室（ICU）的0-59个月SAM儿童，有咳嗽或呼吸困难和放射性肺炎病史，入院时评估为重度脓毒症，构成研究人群。我们比较了肺炎SAM儿童严重脓毒症（病例= 50）与那些没有严重脓毒症（对照= 354）。严重脓毒症是根据客观临床标准定义的，除了抗生素和其他支持治疗外，还根据与世界卫生组织指南非常相似的标准医院指南，通过液体复苏进行管理。病例组病死率显著高于对照组（40% vs.4%; p<0.001）。在调整潜在混杂因素后的逻辑回归分析中，缺乏卡介苗接种、嗜睡、腹胀、急性肾损伤和入院时代谢性酸中毒仍然是肺炎SAM儿童严重脓毒症的独立预测因素（所有比较p<0.05）。我们注意到，与没有严重脓毒症的儿童相比，在5岁以下的SAM儿童中，除了标准抗生素和其他支持治疗外，还需要液体复苏的肺炎和严重脓毒症的病死率要高得多。在我们的研究中，儿童严重脓毒症的独立危险因素和管理结果强调了确定最佳液体复苏治疗以降低此类儿童病死率的重要性。
In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM) children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children. In this retrospective case-control study SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50) with those without severe sepsis (controls = 354). Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline. The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001). In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons). We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.