Functional Outcomes in Pediatric Severe Sepsis: Further Analysis of the Researching Severe Sepsis and Organ Dysfunction in Children: A Global Perspective Trial
Functional Outcomes in Pediatric Severe Sepsis: Further Analysis of the Researching Severe Sepsis and Organ Dysfunction in Children: A Global Perspective Trial
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DOI：
10.1097/pcc.0b013e3182a551c8
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发表时间：
2013-11-01
影响因子：
4.1
通讯作者：
Zimmerman, Jerry J.
中科院分区：
文献类型：
--
作者：
Farris, Reid W. D.;Weiss, Noel S.;Zimmerman, Jerry J.
目的：评估严重败血症后28天存活者功能预后不良的危险因素。设计：回顾队列研究数据，来自全球前瞻性研究(NCT00049764)。背景：18个国家的104个儿科中心。研究对象：患有严重脓毒症的儿童，他们同时需要血管活性肌力输注和机械通气，存活至28天(n=384)。干预：无。测量和主要结果：功能不良被定义为在入选试验28天后，儿科总体表现类别评分大于或等于3，且较基线增加。登记时儿科总体表现类别的中位数为1(四分位数范围为1-2)。28天时儿科总体表现类别的中位数为2(四分位数范围为1-4)。34%的幸存者在28天时功能状态下降，18%的人被确定为功能结果不佳。与白人参照组相比，西班牙裔种族与较差的功能结局相关(风险比=1.9；95%可信区间：1.0-3.0)。与肺部感染相关的临床因素包括中枢神经系统和腹内感染源(风险比分别为3.3；95%CI：1.4-5.6和2.4；95%CI：1.0-4.5)；近期创伤史(风险比=3.9；95%CI：1.4-5.4)；入选前接受心肺复苏(风险比=5.1；95%CI：2.9-5.7)；与儿童死亡风险III评分为0~9的参照组相比，基线儿童死亡风险III评分为20-29(风险比=2.8；95%CI：1.2-5.2)，儿童死亡风险III大于或等于30(风险比=4.5；95%CI：1.6-8.0)。结论：在28天存活的儿童严重脓毒症患者中，功能状态普遍下降。这一分析提供了证据，证明特定的患者特征和个人临床病程的方面与严重脓毒症发病28天后的功能预后不良有关。这些特征可能为干预提供机会，以改善患有严重脓毒症的儿童患者的功能结局。严重脓毒症发病28天后功能状态下降是一种常见且具有潜在临床意义的事件。在未来的儿科败血症临床试验中，应考虑将功能状态作为主要结果。
Objectives: To evaluate risk factors for poor functional outcome in 28-day survivors after an episode of severe sepsis.Design: Retrospective cohort study examining data from the Researching Severe Sepsis and Organ Dysfunction in Children: A Global Perspective trial (NCT00049764).Setting: One hundred and four pediatric centers in 18 countries.Subjects: Children with severe sepsis who required both vasoactive-inotropic infusions and mechanical ventilation and who survived to 28 days (n = 384).Interventions: None.Measurements and Main Results: Poor functional outcome was defined as a Pediatric Overall Performance Category score greater than or equal to 3 and an increase from baseline when measured 28 days after trial enrollment. Median Pediatric Overall Performance Category at enrollment was 1 (interquartile range, 1-2). Median Pediatric Overall Performance Category at 28 days was 2 (interquartile range, 1-4). Thirty-four percent of survivors had decline in their functional status at 28 days, and 18% were determined to have a poor functional outcome. Hispanic ethnicity was associated with poor functional outcome compared to the white referent group (risk ratio = 1.9; 95% CI: 1.0-3.0). Clinical factors associated with increased risk of poor outcome included CNS and intra-abdominal infection sources compared to the lung infection referent category (risk ratio = 3.3; 95% CI: 1.4-5.6 and 2.4; 95% CI: 1.0-4.5, respectively); a history of recent trauma (risk ratio = 3.9; 95% CI: 1.4-5.4); receipt of cardiopulmonary resuscitation prior to enrollment (risk ratio = 5.1; 95% CI: 2.9-5.7); and baseline Pediatric Risk of Mortality III score of 20-29 (risk ratio = 2.8; 95% CI: 1.2-5.2) and Pediatric Risk of Mortality III greater than or equal to 30 (risk ratio = 4.5; 95% CI: 1.6-8.0) compared to the referent group with Pediatric Risk of Mortality III scores of 0-9.Conclusions: In this sample of 28-day survivors of pediatric severe sepsis diminished functional status was common. This analysis provides evidence that particular patient characteristics and aspects of an individual's clinical course are associated with poor functional outcome 28 days after onset of severe sepsis. These characteristics may provide opportunity for intervention in order to improve functional outcome in pediatric patients with severe sepsis. Decline in functional status 28 days after onset of severe sepsis is a frequent and potentially clinically meaningful event. Utilization of functional status as the primary outcome in future pediatric sepsis clinical trials should be considered.