Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study
Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study
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DOI：
10.1164/rccm.201412-2323oc
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发表时间：
2015-05-15
影响因子：
24.7
通讯作者：
Thomas, Neal J.
中科院分区：
文献类型：
--
作者：
Weiss, Scott L.;Fitzgerald, Julie C.;Thomas, Neal J.
原理：关于重症儿童严重脓毒症的国际负担，现有数据有限。
目的：描述儿科重症监护病房中严重脓毒症的全球患病率、治疗方法和预后，以便更好地为干预性试验提供依据。
方法：2013年至2014年期间，在26个国家的128个地点进行了为期5天的时点患病率研究。纳入符合共识标准定义的18岁以下严重脓毒症患者。观察指标包括严重脓毒症时点患病率、所采用的治疗方法、新发或进展性多器官功能障碍、第28天无呼吸机和无血管活性药物天数、功能状态以及死亡率。
测量及主要结果：在筛选的6925名患者中，569人患有严重脓毒症（患病率为8.2%；95%置信区间为7.6 - 8.9%）。患者的中位年龄为3.0岁（四分位间距[IQR]为0.7 - 11.0岁）。最常见的感染部位是呼吸道（40%）和血液（19%）。常见的治疗方法包括机械通气（74%的患者）、血管活性药物输注（55%）和皮质类固醇（45%）。医院死亡率为25%，且在不同年龄以及发达国家和资源有限国家之间无差异。无呼吸机天数的中位数为16天（IQR为0 - 25天），无血管活性药物天数为23天（IQR为12 - 28天）。67%的患者在脓毒症确诊时存在多器官功能障碍，其中30%随后出现新发或进展性多器官功能障碍。在幸存者中，17%至少出现中度残疾。在干预性试验中，检测结果绝对风险降低5 - 10%所需的样本量估计为每组165 - 1437名患者。
结论：儿科严重脓毒症仍然是一个沉重的公共卫生问题，其患病率、发病率和死亡率与重症成年人群体中所报道的相似。针对患有严重脓毒症儿童的国际临床试验是有必要的。
Rationale: Limited data exist about the international burden of severe sepsis in critically ill children.Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials.Methods: A point prevalence study was conducted on 5 days throughout 2013-2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator- and vasoactive-free days at Day 28, functional status, and mortality. Measurements andMain Results: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6-8.9%). The patients' median age was 3.0 (interquartile range [IQR], 0.7-11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resource-limited countries. Median ventilator-free days were 16 (IQR, 0-25), and vasoactive-free days were 23 (IQR, 12-28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5-10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,437 patients per group.Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.