Criteria for Pediatric Sepsis-A Systematic Review and Meta-Analysis by the Pediatric Sepsis Definition Taskforce.
Criteria for Pediatric Sepsis-A Systematic Review and Meta-Analysis by the Pediatric Sepsis Definition Taskforce.
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DOI：
10.1097/ccm.0000000000005294
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发表时间：
2022-01-01
影响因子：
8.8
通讯作者：
Pediatric Sepsis Definition Taskforce of the Society of Critical Care Medicine
中科院分区：
文献类型：
--
作者：
Menon K;Schlapbach LJ;Akech S;Argent A;Biban P;Carrol ED;Chiotos K;Jobayer Chisti M;Evans IVR;Inwald DP;Ishimine P;Kissoon N;Lodha R;Nadel S;Oliveira CF;Peters M;Sadeghirad B;Scott HF;de Souza DC;Tissieres P;Watson RS;Wiens MO;Wynn JL;Zimmerman JJ;Sorce LR;Pediatric Sepsis Definition Taskforce of the Society of Critical Care Medicine
补充数字内容可在正文中找到。确定人口统计学、临床、实验室、器官功能障碍和疾病严重程度变量值与：1)感染儿童的脓毒症、严重脓毒症或感染性休克的相关性；以及2)败血症、严重败血症或感染性休克儿童的多器官功能障碍或死亡的关系。检索Medline、Embase和Cochrane中央对照试验登记系统，检索时间为2004年1月1日至2020年11月16日。病例对照研究、队列研究和随机对照试验，研究对象为怀孕后大于或等于37周至18岁的疑似或确诊感染的儿童，在标题或摘要中包括术语“败血症”、“败血症”或“败血症休克”。从符合条件的文章中提取研究特征、患者人口统计学、临床体征或干预、实验室价值、器官功能障碍测量和疾病严重程度评分。采用随机效应Meta分析。106项研究符合资格标准，其中81项纳入荟萃分析。16项研究(9,629名患者)提供了败血症、严重败血症或感染性休克结果的数据，71项研究(154,674名患者)提供了死亡结果的数据。在感染的儿童中，意识水平下降和较高的儿科死亡风险评分与脓毒症/严重脓毒症相关。在脓毒症/严重脓毒症/感染性休克的儿童中，慢性疾病、肿瘤诊断、血管活性/变力药物的使用、机械通气、血清乳酸、血小板计数、纤维蛋白原、降钙素原、多器官功能障碍综合征、儿科逻辑器官功能障碍评分、儿科死亡指数-3和儿科死亡风险评分均与死亡率显著相关。脓毒症、严重败血症和感染性休克患者的合并死亡率在高、高、中、低中等收入国家不同(p<；0.0001)。在感染和败血症的儿童中，器官功能障碍的几个标志物与感兴趣的结果之间的强烈关联支持它们被纳入儿科败血症定义工作组的数据验证阶段。
Supplemental Digital Content is available in the text. To determine the associations of demographic, clinical, laboratory, organ dysfunction, and illness severity variable values with: 1) sepsis, severe sepsis, or septic shock in children with infection and 2) multiple organ dysfunction or death in children with sepsis, severe sepsis, or septic shock. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2004, and November 16, 2020. Case-control studies, cohort studies, and randomized controlled trials in children greater than or equal to 37-week-old postconception to 18 years with suspected or confirmed infection, which included the terms “sepsis,” “septicemia,” or “septic shock” in the title or abstract. Study characteristics, patient demographics, clinical signs or interventions, laboratory values, organ dysfunction measures, and illness severity scores were extracted from eligible articles. Random-effects meta-analysis was performed. One hundred and six studies met eligibility criteria of which 81 were included in the meta-analysis. Sixteen studies (9,629 patients) provided data for the sepsis, severe sepsis, or septic shock outcome and 71 studies (154,674 patients) for the mortality outcome. In children with infection, decreased level of consciousness and higher Pediatric Risk of Mortality scores were associated with sepsis/severe sepsis. In children with sepsis/severe sepsis/septic shock, chronic conditions, oncologic diagnosis, use of vasoactive/inotropic agents, mechanical ventilation, serum lactate, platelet count, fibrinogen, procalcitonin, multi-organ dysfunction syndrome, Pediatric Logistic Organ Dysfunction score, Pediatric Index of Mortality-3, and Pediatric Risk of Mortality score each demonstrated significant and consistent associations with mortality. Pooled mortality rates varied among high-, upper middle-, and lower middle-income countries for patients with sepsis, severe sepsis, and septic shock (p < 0.0001). Strong associations of several markers of organ dysfunction with the outcomes of interest among infected and septic children support their inclusion in the data validation phase of the Pediatric Sepsis Definition Taskforce.