ABSTRACT
Objective:To dynamically monitor the pediatric sequential organ failure assessment(pSOFA) score of children in PICU at different time points, and to evaluate the predictive value of pSOFA score for the prognosis of children with sepsis.Methods:A multicenter prospective observational study was conducted to collect the data of children with sepsis admitted to the PICU of four children′s hospitals in Shanghai from December 2018 to December 2019(Children′s Hospital of Fudan University, Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Children′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, and Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine). We collected their pSOFA scores on the 1st, 3rd, and 7th day after sepsis diagnosis and the highest score.The patients were divided into survival group and death group according to the clinical outcomes at the time of leaving PICU.The clinical characteristics of two groups were compared.Receiver operating characteristic(ROC) curve were used to assess the resolution of the pSOFA score.Logistic regression was used to analyze the relationship between pSOFA score and sepsis mortality.Results:A total of 170 cases diagnosed sepsis were included, with a median age of 32.5(11.5, 83.2) months, and a median length of stay in PICU of 10(6, 21) days.Forty-two died and 128 survived.The medians of the 1st, 3rd, 7th day and the highest pSOFA score of the children in death group[10(7, 12) points, 9(5, 10) points, 7(4, 10) points, 11(7, 12) points, respectively] were higher than those in survival group[4(2, 8) points, 3(1, 6) points, 2(0, 5) points, 6(3, 8) points, respectively]( P<0.05). The area under the ROC curve of the pSOFA score predicting death on day 1 after sepsis diagnosis was greater than that on days 3, 7 and the highest pSOFA score[0.84(95% CI 0.79-0.91) vs.0.80(95% CI 0.71-0.89), 0.77(95% CI 0.65-0.89), 0.83(95% CI 0.77-0.90)], but the difference was not statistically significant( χ2=1.660, P=0.646). The pSOFA score on the first day of diagnosis had the best cut-off value of >6 points for predicting the risk of death from sepsis, with a sensitivity of 97.6% and a specificity of 53.9%.Logistic regression analysis of pSOFA score and childhood sepsis death showed that the OR values corresponding to the 1st, 3rd, 7th day of diagnosis and the highest pSOFA score were 1.58(95% CI 1.350-1.840), 1.39(95% CI 1.218-1.595), 1.38(95% CI 1.184-1.617) and 1.55(95% CI 1.333-1.800), respectively(all P<0.05). The 1-point increase in pSOFA score on the first day of diagnosis of sepsis was associated with a 58% increase in the hazard ratio for death, and each 1-point increase in the highest pSOFA score was associated with a 55% increase in the hazard ratio for death. Conclusion:The 1st, 3rd, 7th day of sepsis diagnosis and the highest pSOFA score could better predict the mortality risk of sepsis in children.Dynamic monitoring of the pSOFA score at different time points has a certain clinical value in predicting the progression and prognosis of children with sepsis.
ABSTRACT
Objective:To dynamically monitor the pediatric sequential organ failure assessment(pSOFA) score of children in PICU at different time points, and to evaluate the predictive value of pSOFA score for the prognosis of children with sepsis.Methods:A multicenter prospective observational study was conducted to collect the data of children with sepsis admitted to the PICU of four children′s hospitals in Shanghai from December 2018 to December 2019(Children′s Hospital of Fudan University, Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Children′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, and Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine). We collected their pSOFA scores on the 1st, 3rd, and 7th day after sepsis diagnosis and the highest score.The patients were divided into survival group and death group according to the clinical outcomes at the time of leaving PICU.The clinical characteristics of two groups were compared.Receiver operating characteristic(ROC) curve were used to assess the resolution of the pSOFA score.Logistic regression was used to analyze the relationship between pSOFA score and sepsis mortality.Results:A total of 170 cases diagnosed sepsis were included, with a median age of 32.5(11.5, 83.2) months, and a median length of stay in PICU of 10(6, 21) days.Forty-two died and 128 survived.The medians of the 1st, 3rd, 7th day and the highest pSOFA score of the children in death group[10(7, 12) points, 9(5, 10) points, 7(4, 10) points, 11(7, 12) points, respectively] were higher than those in survival group[4(2, 8) points, 3(1, 6) points, 2(0, 5) points, 6(3, 8) points, respectively]( P<0.05). The area under the ROC curve of the pSOFA score predicting death on day 1 after sepsis diagnosis was greater than that on days 3, 7 and the highest pSOFA score[0.84(95% CI 0.79-0.91) vs.0.80(95% CI 0.71-0.89), 0.77(95% CI 0.65-0.89), 0.83(95% CI 0.77-0.90)], but the difference was not statistically significant( χ2=1.660, P=0.646). The pSOFA score on the first day of diagnosis had the best cut-off value of >6 points for predicting the risk of death from sepsis, with a sensitivity of 97.6% and a specificity of 53.9%.Logistic regression analysis of pSOFA score and childhood sepsis death showed that the OR values corresponding to the 1st, 3rd, 7th day of diagnosis and the highest pSOFA score were 1.58(95% CI 1.350-1.840), 1.39(95% CI 1.218-1.595), 1.38(95% CI 1.184-1.617) and 1.55(95% CI 1.333-1.800), respectively(all P<0.05). The 1-point increase in pSOFA score on the first day of diagnosis of sepsis was associated with a 58% increase in the hazard ratio for death, and each 1-point increase in the highest pSOFA score was associated with a 55% increase in the hazard ratio for death. Conclusion:The 1st, 3rd, 7th day of sepsis diagnosis and the highest pSOFA score could better predict the mortality risk of sepsis in children.Dynamic monitoring of the pSOFA score at different time points has a certain clinical value in predicting the progression and prognosis of children with sepsis.
ABSTRACT
Ventilator associated pneumonia(VAP)is one of the major source of nosocomial infection in PICU, of which the pathogenesis remains unclear.Recent metataxonomic and metagenomic technologies, from 16S ribosomal RNA to whole genome sequencing, have revealed that healthy lungs harbor a dynamic ecosystem of bacteria and dysbiosis of the respiratory microbiome involved in the pathogenesis and progression of VAP.Recent studies have illustrated that the imbalance of species diversity and abundance of lung microbiome might be the underlying cause of VAP through regulating local mucosal immune response.These methods offer the potential to better interrogate the relationship between an intubated individual′s respiratory microbiota and the underlying disease process to provide important insights into the pathogenesis of VAP, optimizing disease surveillance and multi-drug resistant microbes detection.
ABSTRACT
Ventilator associated pneumonia(VAP)is one of the major source of nosocomial infection in PICU, of which the pathogenesis remains unclear.Recent metataxonomic and metagenomic technologies, from 16S ribosomal RNA to whole genome sequencing, have revealed that healthy lungs harbor a dynamic ecosystem of bacteria and dysbiosis of the respiratory microbiome involved in the pathogenesis and progression of VAP.Recent studies have illustrated that the imbalance of species diversity and abundance of lung microbiome might be the underlying cause of VAP through regulating local mucosal immune response.These methods offer the potential to better interrogate the relationship between an intubated individual′s respiratory microbiota and the underlying disease process to provide important insights into the pathogenesis of VAP, optimizing disease surveillance and multi-drug resistant microbes detection.
ABSTRACT
Objective To construct the permanent colostomy patients with rectal cancer in archives information module content. Methods Using expert meeting,semi- structured interview, literature review, Delphi expert consultation method, establish the system of permanent rectal cancer patients file information specific module. Results In two- round consultation authority coefficient was 0.847. Kendall coordination coefficient (Kendall′s W) was 0.195-0.331, the difference had statistical significance (P<0.01); through the expert consultation method to construct the file information module for permanent colostomy patients with rectal cancer, which contained 4 first-level indicators (colostomy patient information module, stoma nursing modules, stoma patients transitional care modules, colostomy patients with network platform module), 11 secondary indicators, 36 third grade indicators. Conclusions This study established file information module content for permanent stoma patients with rectal cancer. It has good scientificity and reliability, and can provide a theoretical basis for the clinical development of a file information system network for transitional care of permanent stoma patients with rectal cancer.