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马拉维儿童脑疟疾多器官功能障碍综合征

Hunter J Wynkoop¹, Alistair Bevan², Xochilt Galeano³

¹Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.

The American journal of tropical medicine and hygiene

|October 8, 2024

概括

儿童的大脑疟疾 (CM) 通常导致多器官功能障碍综合征 (MODS). 儿科物流器官功能障碍-2 (PELOD-2) 和儿科序列器官衰竭评估 (pSOFA) 评分有效预测儿科CM患者的死亡率.

科学领域:

儿科重症监护医药儿科重症监护医药
传染病传染病传染病
全球卫生健康全球卫生健康

背景情况:

大脑疟疾 (CM) 是疟疾的一种严重的儿科并发症,死亡率高.
多器官功能障碍综合征 (MODS) 与成人CM的死亡率增加有关,但儿童的患病率尚不清楚.
在儿科CM中对MODS的有效评估工具对于改善患者的治疗结果至关重要.

研究的目的:

调查儿科CM患者中MODS的频率和严重程度.
评估四个评分系统 (PELOD-2,pSOFA,SICK,LODS) 在预测儿科CM死亡率和诊断MODS方面的表现.
确定在资源有限的环境中对MODS评估的潜在改进.

主要方法:

对199名入院于马拉维布兰泰尔转诊医院的儿科CM患者的回顾性研究 (2019年1月 - 2023年5月).
从患者病历中抽取数据,使用PELOD-2,pSOFA,SICK和LODS计算得分.
对评分系统在预测死亡率 (曲线下的面积) 和诊断MODS方面的性能进行分析.

主要成果:

总体死亡率为16% (32/199名患者).
与SICK和LODS相比,PELOD-2和pSOFA得分显示出较高的死亡率预测精度 (AUC分别为0.75和0.67).
在高比例的患者中,MODS被诊断为:91%的PELOD-2和86%的pSOFA,相比之下,50%的SICK和15%的LODS.

结论:

PELOD-2和pSOFA评分系统在识别MODS和预测儿科CM中的死亡率方面是有效的.
这些评分系统通常需要实验室数据,在疟疾流行地区可能无法获得这些数据.
开发简化,可访问的评分系统的MODS在儿科CM是需要更好的资源配置和及时治疗.

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