2010-2020年覆盖的单中心队列中的儿科败血症表型:日1日3日轨迹的演变和潜在的预后值
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Zachary Aldewereld1,2, Christopher Horvat1,3, Gilles Clermont4,5
1Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
概括
儿科败血症表型在前三天显著演变. 虽然第3天的分类可以更好地预测结果,但使用第1天数据进行早期识别是具有挑战性的,需要新的方法来改善败血症管理.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 传染病流行病学 传染病流行病学
- 临床信息学是一种临床信息学.
背景情况:
- 败血症表型分类有助于预测患者的结果.
- 早期识别败血症表型对于及时干预至关重要.
- 了解儿科败血症的表型演变对于治疗策略至关重要.
研究的目的:
- 与第一天相比,评估第3天败血症表型分类的临床实用性.
- 确定是否可以使用1日可用的常规临床数据可靠地识别第3天败血症表型.
主要方法:
- 一项对1828名儿科患者的回顾性队列研究,这些患者因疑似感染而入院于儿科重症监护室 (PICU).
- 分析了2010-2014年和2018-2020年期间管理的患者,接受至少7天的全身抗生素.
- 利用多项逻辑回归和随机森林模型来从第一天的数据中预测第3天的表型.
主要成果:
- 在儿科患者中,从第1天到第3天观察到败血症表型的显著演变 (31.7-60.9%保持相同类型).
- 在第3天被归类为D型的患者的结果最差,死亡率高达16.6% (D型在两天) 和11.3% (C型在第1天,D型在第3天).
- 使用1日数据对第3天表型的统计预测很差,这表明早期识别存在挑战.
结论:
- 儿科败血症表型在疾病的前三天内表现出显著的演变.
- 第三天的表型似乎提供了更准确的预后价值,但早期识别仍然很困难.
- 需要新的方法来提高使用早期临床数据可靠预测败血症表型.
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