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首页> 外文期刊>Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies >A Multicenter Network Assessment of Three Inflammation Phenotypes in Pediatric Sepsis-Induced Multiple Organ Failure
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A Multicenter Network Assessment of Three Inflammation Phenotypes in Pediatric Sepsis-Induced Multiple Organ Failure

机译：三种炎症表型在儿科脓毒症诱导多器官衰竭中的多中心网络评估

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Objectives: Ongoing adult sepsis clinical trials are assessing therapies that target three inflammation phenotypes including 1) immunoparalysis associated, 2) thrombotic microangiopathy driven thrombocytopenia associated, and 3) sequential liver failure associated multiple organ failure. These three phenotypes have not been assessed in the pediatric multicenter setting. We tested the hypothesis that these phenotypes are associated with increased macrophage activation syndrome and mortality in pediatric sepsis. Design: Prospective severe sepsis cohort study comparing children with multiple organ failure and any of these phenotypes to children with multiple organ failure without these phenotypes and children with single organ failure. Setting: Nine PICUs in the Eunice Kennedy Shriver National Institutes of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Patients: Children with severe sepsis and indwelling arterial or central venous catheters. Interventions: Clinical data collection and twice weekly blood sampling until PICU day 28 or discharge. Measurements and Main Results: Of 401 severe sepsis cases enrolled, 112 (28%) developed single organ failure (0% macrophage activation syndrome 0/112; < 1% mortality 1/112), whereas 289 (72%) developed multiple organ failure (9% macrophage activation syndrome 24/289; 15% mortality 43/289). Overall mortality was higher in children with multiple organ and the phenotypes (24/101 vs 20/300; relative risk, 3.56; 95% CI, 2.06-6.17). Compared to the 188 multiple organ failure patients without these inflammation phenotypes, the 101 multiple organ failure patients with these phenotypes had both increased macrophage activation syndrome (19% vs 3%; relative risk, 7.07; 95% CI, 2.72-18.38) and mortality (24% vs 10%; relative risk, 2.35; 95% CI, 1.35-4.08). Conclusions: These three inflammation phenotypes were associated with increased macrophage activation syndrome and mortality in pediatric sepsis-induced multiple organ failure. This study provides an impetus and essential baseline data for planning multicenter clinical trials targeting these inflammation phenotypes in children.
机译：目的：正在进行的成年败血症临床试验正在评估靶向三种炎症表型的疗法，包括1）免疫分析相关，2）血栓细胞病变驱动血小板减少相关，3）序贯肝功能衰竭相关的多器官衰竭。在儿科多中心设置中尚未评估这三种表型。我们测试了这些表型与儿科败血症中增加的巨噬细胞激活综合征和死亡率相关的假设。设计：前瞻性败血症队列研究与多种器官衰竭的儿童与多种器官损失的任何表型和单个器官衰竭的儿童进行了多种器官衰竭的儿童对患儿的研究比较。环境：九豆九丝塞内西亚国家儿童健康和人类发展研究院合作小儿主护理研究网络。患者：严重脓毒症和留置动脉或中央静脉导管的儿童。干预措施：临床数据收集和每周两次血液采样，直到PICU第28天或放电。测量和主要结果：401例令人严重的败血症病例，112例（28％）开发出单器官衰竭（0％巨噬细胞激活综合征0/112; <1％死亡率1/112），而289（72％）开发了多种器官衰竭（9％巨噬细胞激活综合征24/289; 15％死亡率43/289）。具有多个器官和表型的儿童的总体死亡率较高（24/101 vs 20/300;相对风险，3.56; 95％CI，2.06-6.17）。与188名没有这些炎症表型的多器官失败患者相比，101例具有这些表型的多器官衰竭患者的巨噬细胞活化综合征增加（19％vs 3％;相对风险，7.07; 95％CI，2.72-18.38）和死亡率（24％vs 10％;相对风险，2.35; 95％CI，1.35-4.08）。结论：这三种炎症表型与儿科败血症诱导的多器官衰竭增加的巨噬细胞活化综合征和死亡率有关。本研究提供了针对靶向儿童这些炎症表型的多中心临床试验的推动力和基本基线数据。

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