Objective: To analyze the clinical characteristics of predictors in pediatric acute leukemia complicated with septic shock and explore the prognostic factors.
Methods: The clinical characteristics of 70 children with acute leukemia and complicated with septic shock hospitalized in Sun Yat-sen Memorial Hospital from March 2012 to March 2021 were retrospectively analyzed. The clinical characteristics of patients in survival group and death group were analyzed and compared. Multiple logistic regression was used to test for predictors of death.
Results: Among the 70 children, 41 were males and 29 were females, with a median age of 7.0 (1.0-15.0) years old. 81.4% were hospital acquired infections. The pathogens were mostly Gram-negative bacteria (50/66, 75.8%) and the clinical manifestations were cold shock. Mortality rate was 34.3% (24/70). The length of hospitalization, duration of fever and antibiotic exposure longevity before the onset of septic shock were significantly different between survival group and death group. At septic shock onset, compared with the survival group, patients in the death group were younger, had lower platelet counts and higher levels of C-reactive protein and procalcitonin, and were more likely to have acute heart failure and more mechanical ventilation (all p<0.05). The results of multivariable analysis showed that mortality was independently associated with pediatric sequential organ failure assessment score (pSOFA) (odds ratio: 1.616, 95% CI: 1.160-2.251, p=0.005) and acute heart failure (odds ratio: 18.308, 95% CI: 1.939-172.911, p=0.011). In addition, the ROC curve analysis showed that pSOFA score had AUC of 0.8551 (95% CI: 0.7607-0.9495, p<0.001) predicting PICU mortality and its best predictive value was >9.5 (sensitivity 75.0%, specificity 87.0%).
Conclusion: Pediatric acute leukemia complicated with septic shock is characterized as rapid deterioration and high mortality. A pSOFA score greater than 9.5 and acute heart failure are associated with poor outcomes.
题目: 儿童急性白血病合并脓毒性休克临床分析.
目的: 分析儿童急性白血病合并脓毒性休克的临床特点并探讨预后相关因素.
方法: 收集并回顾性分析中山大学孙逸仙纪念医院儿童重症监护室（PICU）2012年3月至2021年3月收治的70例急性白血病合并脓毒性休克患儿的临床资料，分析比较存活组与死亡组患者的临床特点，应用多因素logistic回归分析探讨死亡相关危险因素.
结果: 70例患儿中男41例，女29例，中位年龄为7.0（1.0-15.0）岁。57例（81.4%）为医院获得性感染，病原菌以G-菌为主（50/66，75.8%），临床主要表现为冷休克（64/70，91.4%）。最终24例死亡，病死率为34.3%。与存活组比较，死亡组患者年龄更小，休克前住院时间、发热持续时间及静脉抗生素暴露时间更长，休克时生命体征更不平稳，PLT水平更低、CRP与PCT水平更高，病情严重程度更重，合并心功能不全、需要机械通气的病例更多，比较差异均具有统计学意义（均P＜0.05）。进一步建立logistic回归模型结果显示，儿童序贯器官衰竭评分（pSOFA）（or=1.616，95%CI：1.160-2.251，p=0.005）、合并急性心功能不全（or=18.308，95%CI：1.939-172.911，p=0.011）是急性白血病合并脓毒性休克患儿死亡的独立危险因素。ROC曲线结果显示，pSOFA预测该类患儿死亡的AUC为0.8551（95%CI：0.7607-0.9495，p<0.001）,其最佳预测值为>9.5分（敏感度75.0%，特异度87.0%）.
结论: 急性白血病合并脓毒性休克患儿病情进展迅速、病死率高，当pSOFA>9.5分、合并急性心功能不全时预后不良.
Keywords: acute leukemia; child; prognostic; septic shock.