Association of Fluid Accumulation with Clinical Outcomes in Critically Ill Children with Severe Sepsis.
Association of Fluid Accumulation with Clinical Outcomes in Critically Ill Children with Severe Sepsis.
复制标题
严重脓毒症危重儿童积液与临床结果的关系
DOI：
10.1371/journal.pone.0160093
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Li Y
中科院分区：
文献类型：
--
作者：
Chen J;Li X;Bai Z;Fang F;Hua J;Li Y;Pan J;Wang J;Feng X;Li Y
目的探讨重症脓毒症患儿早期和获得性每日体液超载（FO）以及体液蓄积波动是否与不良结局相关。方法本研究纳入202例重症监护室（PICU）重症脓毒症患儿。早期液体超载定义为在PICU入院前24小时内发生≥5%的液体积聚。在PICU住院至少48小时的患者，在接下来的6天内发生的最大每日液体积聚≥5%被定义为PICU获得性每日液体过载。液体积聚的波动计算为入院后7天内每日最大和最小液体积聚的差值。结果202例患者中，有61例（30.2%）在PICU期间死亡。在所有患者中，41例（20.3%）出现早期液体过载，其中9例FO≥10%。在PICU停留至少48小时的患者（n = 154）中，36例（23.4%）发生PICU获得性每日液体过载，其中2例FO≥10%。在调整年龄、疾病严重程度等因素后，早期液体超载（AOR = 1.20; 95% CI 1.08-1.33; P = 0.001; n = 202）和picu获得性每日液体超载（AOR = 5.47 / log增加；95% CI 1.15-25.96; P = 0.032; n = 154）是与死亡率相关的独立危险因素。然而，体液积聚的波动与调整后的死亡率无关。所有PICU停留至少48小时的患者（FO <5%, 5%-10% vs≥10%;4 [3-8],7 [4 - 11]vs. 10[6-16]天；P <0.001; n = 154）和幸存者（4 [3-8],7 [5-11]vs. 10[5-15]天；P <0.001; n = 121） PICU停留时间随液体积聚波动较大而增加。在预测严重脓毒症患者的死亡率时，早期液体过载的接受者操作特征曲线下面积为0.74 (95% CI 0.65-0.82; P <0.001; n = 202)，敏感性为67.2%，特异性为80.1%，最佳临界值为2.65%。结论：早期和获得性每日体液超载与重症脓毒症患儿PICU死亡率独立相关。
Objective To evaluate whether early and acquired daily fluid overload (FO), as well as fluctuations in fluid accumulation, were associated with adverse outcomes in critically ill children with severe sepsis. Methods This study enrolled 202 children in a pediatric intensive care unit (PICU) with severe sepsis. Early fluid overload was defined as ≥5% fluid accumulation occurring in the first 24 hours of PICU admission. The maximum daily fluid accumulation ≥5% occurring during the next 6 days in patients with at least 48 hours of PICU stay was defined as PICU-acquired daily fluid overload. The fluctuation in fluid accumulation was calculated as the difference between the maximum and the minimum daily fluid accumulation obtained during the first 7 days after admission. Results Of the 202 patients, 61 (30.2%) died during PICU stay. Among all patients, 41 (20.3%) experienced early fluid overload, including 9 with a FO ≥10%. Among patients with at least 48 hours of PICU stay (n = 154), 36 (23.4%) developed PICU-acquired daily fluid overload, including 2 with a FO ≥10%. Both early fluid overload (AOR = 1.20; 95% CI 1.08–1.33; P = 0.001; n = 202) and PICU-acquired daily fluid overload (AOR = 5.47 per log increase; 95% CI 1.15–25.96; P = 0.032; n = 154) were independent risk factors associated with mortality after adjusting for age, illness severity, etc. However, fluctuations in fluid accumulation were not associated with mortality after adjustment. Length of PICU stay increased with greater fluctuations in fluid accumulation in all patients with at least 48 hours of PICU stay (FO <5%, 5%-10% vs. ≥10%: 4 [3–8], 7 [4–11] vs. 10 [6–16] days; P <0.001; n = 154) and in survivors (4 [3–8], 7 [5–11] vs. 10 [5–15] days; P <0.001; n = 121). Early fluid overload achieved an area under-the-receiver-operating-characteristic curve of 0.74 (95% CI 0.65–0.82; P <0.001; n = 202) for predicting mortality in patients with severe sepsis, with a sensitivity of 67.2% and a specificity of 80.1% at the optimal cut-off value of 2.65%. Conclusions Both early and acquired daily fluid overload were independently associated with PICU mortality in children with severe sepsis.