Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock*
Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock*
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DOI：
10.1097/ccm.0000000000004122
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发表时间：
2020-03-01
影响因子：
8.8
通讯作者：
Reeder, Ron W.
中科院分区：
文献类型：
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作者：
Zimmerman, Jerry J.;Banks, Russell;Reeder, Ron W.
目的：一篇配套文章报道了感染性休克儿童长期死亡率和显著健康相关生活质量残疾的轨迹。在这篇文章中，研究人员研究了与这些不良结局相关的危重疾病因素。设计：前瞻性，队列结局研究，2013- 2017年进行。设置：12个美国学术PICU。患者：危重病儿童，1个月至18岁，社区获得性感染性休克，需要血管活性肌力支持。干预：在PICU入院期间收集疾病严重程度，器官功能障碍和资源利用数据。从基线的变化，健康相关的生活质量在3个月的后续评估父母代理报告采用儿科生活质量量表或Stein-Pastop功能状态Scale.Measurements和主要结果：在单变量建模，危重病变量与死亡和/或持续的，严重的健康相关的生活质量恶化的候选人多变量建模使用贝叶斯信息标准。在具有接近最佳统计拟合的模型中选择最具临床相关性的多变量模型。感染性休克后3个月，389例受试者中有346例（88.9%）存活，43例（11.1%）死亡; 389例受试者中有203例（52.2%）完成了配对的健康相关生活质量调查。在单变量模型中，儿童死亡风险、儿童Logistic器官功能障碍累积评分、PICU和住院时间、最大和累积血管活性-变力性评分、机械通气持续时间、肾脏替代治疗、体外生命支持或心肺复苏的需要以及病理性神经体征的出现与不良结局相关。在多元回归分析中（比值比[95% CI]），每日儿科逻辑器官功能障碍评分总和，1.01/每分（1.01-1.02），P < 0.001;最高血管活性变力性评分，1.02/分（1.00-1.04），p = 0.003;任何急性病理性神经系统体征/事件，5.04（2.15-12.01），p < 0.001与3个月时死亡或持续、严重的健康相关生活质量恶化独立相关。与脓毒症相关的危重病器官功能障碍及其治疗相关的生物学合理因素与脓毒症休克患儿3个月随访时的不良结局相关。
Objectives:A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes.Design:Prospective, cohort-outcome study, conducted 2013-2017.Setting:Twelve United States academic PICUs.Patients:Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.Interventions:Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale.Measurements and Main Results:In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3.Conclusions and Relevance:Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock.