Day 1 multiple organ dysfunction syndrome is associated with poor functional outcome and mortality in the pediatric intensive care unit.
Day 1 multiple organ dysfunction syndrome is associated with poor functional outcome and mortality in the pediatric intensive care unit.
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DOI：
10.1097/pcc.0b013e3181a64be1
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发表时间：
2009-09
期刊：
影响因子：
--
通讯作者：
Mariscalco MM
中科院分区：
文献类型：
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作者：
Typpo KV;Petersen NJ;Hallman DM;Markovitz BP;Mariscalco MM
多器官功能障碍综合征（MODS）的流行病学和结果是不完全的特点，在儿科人群中，由于样本量小，器官衰竭的诊断相互矛盾。我们试图根据器官衰竭的共识定义，在PICU患者的大型临床数据库中描述早期MODS的流行病学和结局。回顾性分析同期收集的临床PICU数据库。VPICU绩效系统（VPS）数据库中35家美国儿童医院2004年1月至2005年12月的患者入院情况。我们在VPS数据库中评估了2004年1月至2005年12月期间63，285例连续PICU入院患者。我们排除了<1 month or >18岁的患者和MODS变量缺失值>10%的医院。我们根据国际儿科脓毒症共识会议（IPSCC）标准以及第1天实验室和生命体征值确定了第1天的MODS。我们使用儿科总体性能分类（POPC）和儿科大脑性能分类（PCPC）评分从PICU入院和出院时评估功能状态。分析：Student t检验、R2、Mann-Whitney秩和、Kruskal-Wallis、线性和逻辑回归。我们分析了来自28家符合纳入标准的医院的44，693例住院患者。总体PICU死亡率为2.8%。我们确定了18.6%的入院患者在第1天发生MODS。第1天发生MODS的患者死亡率较高（10.0% v. 1.2%，p<0.001），PICU住院时间较长（3.6 v. 1.3天，p<0.001），PICU出院时POPC和PCPC评分较基线变化较大（p<0.001）。与其他年龄组相比，婴儿具有最高的第1天MODS发生率（25.2%对16.5%，p<0.001）。使用迄今为止最大的临床数据集和对器官衰竭的共识定义，我们发现在ICU入院的第一天出现MODS的儿童比第一天没有MODS的儿童有更差的功能结局，更高的死亡率和更长的PICU住院时间。婴儿易受MODS的影响。
The epidemiology and outcomes of Multiple Organ Dysfunction Syndrome (MODS) are incompletely characterized in the pediatric population due to small sample size and conflicting diagnoses of organ failure. We sought to describe the epidemiology and outcomes of early MODS in a large clinical database of PICU patients based on consensus definitions of organ failure. Retrospective analysis of a contemporaneously collected clinical PICU database. VPICU Performance System (VPS) database patient admissions from 1/2004-12/2005 for 35 US children’s hospitals. We evaluated 63,285 consecutive PICU admissions from 1/2004-12/2005 in the VPS database. We excluded patients <1 month or >18 years of age, and hospitals with >10% missing values for MODS variables. We identified day 1 MODS by International Pediatric Sepsis Consensus Conference (IPSCC) criteria with day 1 laboratory and vital sign values. We evaluated functional status using Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) scores from PICU admission and discharge. Analysis: Student’s t-test, Χ2, Mann-Whitney rank sum, Kruskal-Wallis, linear and logistic regression. We analyzed 44,693 admissions from 28 hospitals meeting inclusion criteria. Overall PICU mortality was 2.8%. We identified day 1 MODS in 18.6% of admissions. Patients with day 1 MODS had higher mortality (10.0% v. 1.2%, p<0.001), longer PICU length of stay (3.6 v. 1.3 days, p<0.001) and larger change from baseline POPC and PCPC scores at time of PICU discharge (p<0.001). Infants had the highest incidence of day 1 MODS (25.2% vs. 16.5%, p<0.001) compared to other age groups. Using the largest clinical dataset to date and consensus definitions for organ failure, we found that children with MODS present on day one of ICU admission have worse functional outcomes, higher mortality, and longer PICU length of stay than children who do not have MODS on day one. Infants are disproportionally affected by MODS.