Analysis Of Prognosis And Influencing Factors Of Continuous Blood Purification In Children With Severe Sepsis

Sepsis refers to systemic inflammatory response syndrome(SIRS)caused by infection;severe sepsis refers to organ dysfunction or tissue hypoperfusion caused by sepsis[1].The incidence in children with sepsis or severe sepsis is increasing year by year,and its mortality rate is high.In recent years,although antibiotics are widely used and various comprehensive treatments continue to improve,their mortality rate is still not significantly reduced.Continuous blood purification(CBP)technology is an important advance in the field of critical care medicine in the past 20 years and has become a new means of treating severe sepsis.CBP began to be used in the field of pediatrics in China in 2000 and has developed rapidly.With the maturity and standardization of continuous CBP technology,as well as its advantages of small effect on hemodynamics,high solute clearance rate,better biocompatibility,and ability to remove inflammatory mediators and inflammatory factors,its application in children with sepsis and severe sepsis is increasing,and its therapeutic effect has been increasingly affirmed.In 2012,the Expert Committee of Pediatric Critical Care Physicians Branch of Chinese Medical Doctor Association issued the Expert Consensus on Continuous Blood Purification for the Treatment of the Children with Severe Sepsis,recommending that CBP can be used for the treatment of severe sepsis in children and proposing the application.However,the efficacy of continuous blood purification for the treatment of the children with severe sepsis,is still controversial[2].ObjectiveTo investigate the prognosis and influencing factors of continuous blood purification in the treatment of the children with severe sepsis.MethodsA retrospective cohort study was conducted to collect the clinical data of 181 children with severe sepsis and/or septic shock admitted to the Pediatric Intensive Care Unit(PICU)of Shandong Provincial Hospital from January 2016 to December 2019.The patients were divided into blood purification group and non-blood purification group according to whether they received continuous blood purification.The white blood cell,C-reactive protein,procalcitonin(PCT),T cell failure(CD3+,CD3+CD4+,CD3+CD8+),NK cell(CD16+56+)and IL-6 levels,in-hospital mortality and PICU stay were compared between the two groups at 1d and 5d after treatment.The effect of different infection sites,PICU 24-hour Pediatric Sequential Organ Failure Assessment(pSOFA)and age on in-hospital mortality was studied using propensity score matching method.Results(1)There was no statistical difference in age,gender composition and body weight between the two groups.The 24h-pSOFA score in the blood purification group was significantly higher than that in the non-blood purification group(P<0.01);there was statistical difference in the composition of primary infection site between the two groups(P<0.05);in the treatment methods,the use rate of vasoactive drugs and hormones in the blood purification group was also significantly higher than that in the non-blood purification group.(2)The age,gender,body weight,24h-pSOFA score,primary infection site,mechanical ventilation therapy,volume expansion therapy,use of vasoactive drugs and hormones and other treatment methods of the two groups were matched for propensity score.There was no statistical difference in the in-hospital mortality and PICU stay between the two groups before matching(P>0.05).After matching,the in-hospital mortality of the blood purification group was lower than that of the non-blood purification group,and there was statistical difference(P<0.05).There was no statistical difference in the PICU stay between the two groups(P>0.05).(3)Before treatment,the peripheral blood infection indicators WBC,CRP,PCT and inflammatory factor IL-6 were significantly increased in the two groups,but they are all not statistics differences(P>0.05).But after treatment,all the above indicators of the three groups of children continued to decrease,and the rate and range of decrease in the blood purification group were significantly higher than those in the non-blood purification group(P<0.05).(4)Before treatment,the percentages of CD3+,CD3+CD4+and CD3+CD8+T lymphocytes in the two groups were lower than normal,and the CD4+/CD8+ ratio and NK cell percentage were lower than normal,without statistics differences(P>0.05).But after treatment,all the above indicators continued to increase,and the rate and amplitude of increase were more significant in the blood purification group(P<0.05).(5)Before propensity score matching,there were no statistically significantly different in the in-hospital mortality and the PICU stay time in children with different primary infection sites(respiratory system,nervous system,digestive system,and blood system)between the two groups(P>0.05);after matching,in children with primary infection sites of respiratory system infection,the in-hospital mortality and PICU stay in the blood purification group was lower than those in the non-blood purification group,and there were statistically significantly different(P<0.05).(6)Before and after propensity score matching,there were no statistically significantly different in the in-hospital mortality and PICU stay time in children aged≤12 months,13～36 months,37～72 months,and>72 months between the two groups(P>0.05).(7)Before propensity score matching,there was no statistically significat difference in the in-hospital mortality and PICU stay in children with 24-hour pSOFA score≤4,5～8,and ≥9 between the two groups(P>0.05);but after matching,the in-hospital mortality in children with 24-hour pSOFA score>9 was lower in the blood purification group than in the non-blood purification group,and there was a statistically significant difference(P<0.05),but no difference of statistics in PICU stay between the two groups(P>0.05).Conclusion1.Continuous blood purification(CBP)is an effective treatment for severe sepsis in children,and can improve the prognosis of children with severe sepsis.2.Continuous blood purification treatment can significantly improve the prognosis of children with severe sepsis caused by primary respiratory infection and severe sepsis with 24-hour pSOFA≥ 9 points.