New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality.
New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality.
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DOI：
10.1097/pcc.0000000000000978
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发表时间：
2017-01
期刊：
影响因子：
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通讯作者：
Sepsis Prevalence, Outcomes, and Therapy Study Investigators
中科院分区：
文献类型：
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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
描述严重脓毒症患儿新发或进行性多器官功能障碍综合征（NPMODS）的流行病学、发病率和死亡率。一项前瞻性、横断面、时点患病率研究的次要分析。国际多中心儿科重症监护病房。在1年期间的5个不同日期确定的重度脓毒症儿科患者。来自26个国家的128个PICU的567名患者中，384名（68%）在严重脓毒症识别后7天内发生MODS。327例患者在脓毒症识别当天发生MODS。这些患者中有91例发展为进展性MODS，而另外57例随后发展为新的MODS，产生了26%的严重脓毒症相关NPMODS的总比例。进展性MODS患者的住院死亡率为51%，与新发MODS患者（28%）和无MODS的单器官功能障碍患者（10%）相比，p<0.001。NPMODS的幸存者中重度残疾（定义为儿科总体功能分类（POPC）≥ 3且较基线增加≥ 1）的发生率也较高：进行性、新发和无MODS分别为22% vs. 29% vs. 11%，p<0.001。NPMODS的发生在严重脓毒症中很常见（26%），与无NPMODS的严重脓毒症相比，其发病率和死亡率风险更高。我们的数据支持使用NPMODS作为儿科严重脓毒症试验的重要结局，尽管需要努力验证减少NPMODS导致更明确的发病率和死亡率终点的改善。
To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome (NPMODS) in children with severe sepsis. Secondary analysis of a prospective, cross-sectional, point prevalence study. International, multi-center pediatric intensive care units. Pediatric patients with severe sepsis identified on five separate days over a 1 year period. None Of 567 patients from 128 PICUs in 26 countries were enrolled, 384 (68%) developed MODS within seven days of severe sepsis recognition. Three hundred twenty-seven had MODS on day of sepsis recognition. Ninety-one of these patients developed progressive MODS, while an additional 57 subsequently developed new MODS, yielding a total proportion with severe sepsis-associated NPMODS of 26%. Hospital mortality in patients with progressive MODS was 51% compared to patients with new MODS (28%) and those with single-organ dysfunction without MODS (10%), p<0.001. Survivors of NPMODS also had a higher incidence of moderate to severe disability defined as a Pediatric Overall Performance Category (POPC) of ≥ 3 and an increase of ≥ 1 from baseline: 22% vs. 29% vs. 11% for progressive, new, and no MODS, respectively, p<0.001. Development of NPMODS is common (26%) in severe sepsis and was associated with a higher risk of morbidity and mortality than severe sepsis without NPMODS. Our data supports the use of NPMODS as an important outcome in trials of pediatric severe sepsis, though efforts are needed to validate that reducing NPMODS leads to improvements in more definitive morbidity and mortality endpoints.