专输液与儿科败血症和败血症冲击的差异反应的关联:使用美国多中心2012-2018年数据集的回顾性分析
Cheolmin Matthew Lee1,2, Mihir R Atreya3, Tellen D Bennett4
1Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
概括
在儿科败血症休克患者中使用专可以改善生存率. 相比之下,在患有败血症但没有冲击的儿童中,白蛋白对结果没有影响. 这凸显了针对儿科败血症干预措施的需要.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 临床药理学 临床药理学
- 流行病学 流行病学
背景情况:
- 败血症是儿童的一种危及生命的疾病,败血症休克代表了严重的表现.
- 专是一种液体复苏剂,但其在儿科败血症中的作用,特别是在冲击的情况下,需要进一步澄清.
- 了解治疗反应异质性对于优化儿科败血症管理至关重要.
研究的目的:
- 为了研究与毒症儿童的专素的管理和临床结果之间的关联.
- 用因果推断来比较阿尔伯明在患有和没有感染性休克的儿科患者的效果.
- 确定可能受益于败血症中白蛋白治疗的患者子组.
主要方法:
- 来自13个美国儿科重症监护室 (PICU) 的电子健康记录数据的二次分析 (2012-2018).
- 包括在PICU入院24小时内符合败血症标准的儿童 (<18岁).
- 应用共变量平衡倾向得分权重来调整指示偏差,分析重点是24小时的幸存者,以减轻不朽时间偏差.
主要成果:
- 在17,307名儿科败血症幸存者中观察到白蛋白使用和休克状态之间的显著相互作用.
- 在患有败血症休克的儿童中,阿尔伯明的使用与医院内死亡率显著降低有关 (OR 0.698,RR 0.746,HR 0.688).
- 在患有败血症但没有冲击的儿科患者中,在阿尔伯明和对照组之间没有发现结果的显著差异.
结论:
- 早期阿尔伯明的使用在患有败血性休克的儿科患者中显示出生存益处.
- 专类药物治疗似乎不会改变未处于休克状态的败血症儿童的结果.
- 临床异质性,特别是冲击的存在,是确定儿科败血症治疗反应的关键因素,指导更有针对性的干预措施.
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