BACKGROUND:The latest sepsis definition includes both infection and organ failure,as evidenced by the sequential organ failure assessment(SOFA)score.However,the applicability of the pediatric SOFA score(pSOFA)is not y...BACKGROUND:The latest sepsis definition includes both infection and organ failure,as evidenced by the sequential organ failure assessment(SOFA)score.However,the applicability of the pediatric SOFA score(pSOFA)is not yet determined.This study evaluated the effectiveness of both pSOFA and system inflammatory reaction syndrome(SIRS)scores in predicting sepsis-related pediatric deaths.METHODS:This is a retrospective multi-center cohort study including hospitalized patients<18 years old with diagnosed or not-yet-diagnosed infections.Multivariate analyses were carried out to evaluate risk factors for in-hospital mortality.According to Youden index(YI),three sub-categories of pSOFA were screened out and a new simplified pSOFA score(spSOFA)was formed.The effectiveness and accuracy of prediction of pSOFA,SIRS and spSOFA was retrieved from the area under the receiver operating characteristic curve(AUROC)and Delong’s test.RESULTS:A total of 1,092 participants were eligible for this study,and carried a 23.4%in-hospital mortality rate.The 24-h elevated pSOFA score(24 h-pSOFA),bloodstream infection,and mechanical ventilation(MV)requirement were major risk factors associated with sepsis-related deaths.The AUROC analysis confirmed that the spSOFA provided good predictive capability in sepsis-related pediatric deaths,relative to the 24 h-pSOFA and SIRS.CONCLUSIONS:The pSOFA score performed better than SIRS in diagnosing infected children with high mortality risk.However,it is both costly and cumbersome.We,therefore,proposed spSOFA to accurately predict patient outcome,without the disadvantages.Nevertheless,additional investigations,involving a large sample population,are warranted to confirm the conclusion of this study.展开更多
BACKGROUND Hemophagocytic lymphohistiocytosis(HLH)is a severe and potentially deadly condition associated with extensive inflammation and immune activation.Cytokine adsorption may serve as a supportive treatment that ...BACKGROUND Hemophagocytic lymphohistiocytosis(HLH)is a severe and potentially deadly condition associated with extensive inflammation and immune activation.Cytokine adsorption may serve as a supportive treatment that can stabilize organ function in affected patients by reducing their circulating cytokines levels.To date,no descriptions of clinical experiences associated with the use of HA330-II column hemoadsorption for the treatment of children affected by HLH have been published.CASE SUMMARY We describe the case of an 11-year-old child with Epstein-Barr virus-associated HLH complicated by liver failure.She underwent HA330-II column hemoadsorption and chemotherapy and exhibited reductions in levels of inflammatory cytokines,including interleukin(IL),IL-6,IL-8,IL-10,and interferon-γ.The patient’s condition and laboratory parameters gradually improved with treatment.CONCLUSION Hemoadsorption may play an important role in cytokine storm elimination in children with HLH combined with liver failure and consequent multiple organ failure.展开更多
文摘BACKGROUND:The latest sepsis definition includes both infection and organ failure,as evidenced by the sequential organ failure assessment(SOFA)score.However,the applicability of the pediatric SOFA score(pSOFA)is not yet determined.This study evaluated the effectiveness of both pSOFA and system inflammatory reaction syndrome(SIRS)scores in predicting sepsis-related pediatric deaths.METHODS:This is a retrospective multi-center cohort study including hospitalized patients<18 years old with diagnosed or not-yet-diagnosed infections.Multivariate analyses were carried out to evaluate risk factors for in-hospital mortality.According to Youden index(YI),three sub-categories of pSOFA were screened out and a new simplified pSOFA score(spSOFA)was formed.The effectiveness and accuracy of prediction of pSOFA,SIRS and spSOFA was retrieved from the area under the receiver operating characteristic curve(AUROC)and Delong’s test.RESULTS:A total of 1,092 participants were eligible for this study,and carried a 23.4%in-hospital mortality rate.The 24-h elevated pSOFA score(24 h-pSOFA),bloodstream infection,and mechanical ventilation(MV)requirement were major risk factors associated with sepsis-related deaths.The AUROC analysis confirmed that the spSOFA provided good predictive capability in sepsis-related pediatric deaths,relative to the 24 h-pSOFA and SIRS.CONCLUSIONS:The pSOFA score performed better than SIRS in diagnosing infected children with high mortality risk.However,it is both costly and cumbersome.We,therefore,proposed spSOFA to accurately predict patient outcome,without the disadvantages.Nevertheless,additional investigations,involving a large sample population,are warranted to confirm the conclusion of this study.
文摘BACKGROUND Hemophagocytic lymphohistiocytosis(HLH)is a severe and potentially deadly condition associated with extensive inflammation and immune activation.Cytokine adsorption may serve as a supportive treatment that can stabilize organ function in affected patients by reducing their circulating cytokines levels.To date,no descriptions of clinical experiences associated with the use of HA330-II column hemoadsorption for the treatment of children affected by HLH have been published.CASE SUMMARY We describe the case of an 11-year-old child with Epstein-Barr virus-associated HLH complicated by liver failure.She underwent HA330-II column hemoadsorption and chemotherapy and exhibited reductions in levels of inflammatory cytokines,including interleukin(IL),IL-6,IL-8,IL-10,and interferon-γ.The patient’s condition and laboratory parameters gradually improved with treatment.CONCLUSION Hemoadsorption may play an important role in cytokine storm elimination in children with HLH combined with liver failure and consequent multiple organ failure.
