Abstract:
Background: Pediatric sepsis is a life-threatening condition, with extremely high incidence and mortality among critically ill children worldwide.Patients with septic shock are susceptible to intestinal complications due to altered blood flow distribution, and these complications often correlate directly with a poor prognosis. Early detection of low perfusion and appropriate resuscitation are critical components in the management of patients experiencing shock. Nevertheless, significant debate persists regarding the comparative value of various resuscitation targets. While central venous oxygen saturation (ScvO2) monitoring is frequently advocated, it remains a subject of scrutiny. All pathophysiological mechanisms are intricately linked to cellular hypoxia and energy metabolism, which is why metabolic-related biomarkers, particularly lactate and lactate clearance rate, are highly regarded by critical care experts.Nonetheless,limited research has been conducted on the association between markers of circulatory shock and metabolic disorders in critically ill patients particularly in the field of pediatrics.Physiological indicators, particularly those associated with cell energy metabolism,have shown potentials in predicting sepsis and septic shock.
Methods: This was a retrospective study. A total of 63 patients,comprising 30 males and 33 females,who developed septic shock secondary to pediatric primary peritonitis, were admitted to the Intensive Care Department of the Children’s Hospital Affiliated to Xi’an Jiaotong University and the Pediatric Intensive Care Unit of Gansu Provincial Maternity and Child-Care Hospital between December 2016 and December 2021.Based on the primary outcome of 28-day all-cause mortality, patients were assigned into the survival group and nonsurvival group.Demographic and clinical data were compared.Risk factors for the prognosis of septic shock secondary to pediatric primary peritonitis were identified by logistic regression, and their potentials in predicting the 28-day survival were assessed by the receiver operating characteristic and Kaplan-Meier survival curves.
Results: Among the 63 eligible patients with septic shock secondary to pediatric primary peritonitis, 47 survived. In comparison to the survival group, the nonsurvival group showed significantly higher proportions of mechanical ventilation, surgical intervention, and use of vasoactive drugs, procalcitonin, activated partial thromboplastin time, respiratory quotient (RQ), lactate (Lac), the Pediatric Sequential Organ Failure Assessment score, and the Pediatric Risk of Mortality III score, but lower platelet count, fibrinogen, and mean arterial pressure (allP’s < 0.05). RQ (odds ratio [OR],2.37;95% confidence interval [CI],1.41, 3.22; P <0.05)and Lac(OR, 2.01; 95% CI,1.15,3.21; P < 0.05) were independent prognostic factors for septic shock secondary to pediatric primary peritonitis. Their combination (RQ < 1.6 + Lac < 4 mmol/L) achieved a better accuracy in predicting the 28-day cumulative survival.
Conclusion: RQ combined with Lac offers an excellent performance in predicting mortality of septic shock secondary to pediatric primary peritonitis
