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早期的,持久的淋巴缺血与长期的多器官衰竭和败血症儿童的死亡率有关

Bradley S Podd^1,2, Russell K Banks³, Ron Reeder³

¹Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Center for Critical Care Nephrology and Clinical Research Investigation and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, PA.

Critical care medicine

|July 18, 2023

概括

在儿科严重败血症中,早期的持续性淋巴缺血与更糟糕的结果有关,包括长期的器官功能障碍或死亡. 这一发现支持针对有风险儿童的向免疫疗法.

科学领域:

儿科重症监护医药儿科重症监护医药
免疫学免疫学免疫学
败血症的研究研究.

背景情况:

败血症相关的免疫抑制是导致不良结果的已知因素.
成人研究正在探索对败血症的免疫支持疗法.
关于儿童败血症免疫调节的数据有限.

研究的目的:

调查早期,持久性淋巴缺血症与儿科严重败血症的结果之间的关联.
为了测试淋巴缺血预测该人口中更糟糕的结果的假设.

主要方法:

在九个PICU中进行了观察性队列研究.
患有严重败血症的患者根据早期的持续性淋巴缺血 (绝对淋巴细胞计数<1000细胞/μL在研究日0-5之间2天) 进行了分类.
评估的综合结果是长期多器官功能障碍综合征 (MODS) 或PICU死亡率.

主要成果:

在401名儿科重症败血症患者中,38%患有持续性淋巴缺血.
持续的淋巴缺血与长期的MODS或PICU死亡率 (43%对18%) 的风险显著增加有关.
淋巴的患者表现出TNF-α反应受损和炎症标志物升高.

结论:

在儿科重症败血症中,早期的持续性淋巴缺血确定了患有长期MODS或PICU死亡率高风险的患者.
这种风险分层支持在这个患者群体中研究免疫调节疗法.
需要进一步的研究,以根据免疫状况开发针对性治疗儿科败血症的治疗方法.

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