Multivariate Analysis Of Plasma Exchange Treatment In Children With Deep Coma

Objective: Acute non-traumatic coma is one of the common causes of pediatric hospitalization with high mortality rate,which etiology is complex and diverse.Brain injury related to immune mechanism and inflammatory response is one of the important mechanisms of coma.Some studies have shown that therapeutic plasma exchange can remove these substances or reduce the level of them,thereby preventing progression of disease and improving prognosis.However,plasma exchange in children is currently only recommended for the treatment of specific diseases,and there is no uniform implementation standard.The purpose of this study aims to analyze the factors of plasma exchange in children with acute non-traumatic deep coma in PICU.Methods: A retrospective cohort study method was used to select 212 children with acute non-traumatic coma who were hospitalized in the PICU of our hospital from January 2015 to June 2022,and 111 children who met the inclusion criteria were selected as the study subjects.According to whether plasma exchange treatment was performed within 96 hours after admission,they were divided into two groups(plasma exchange group and non-plasma exchange group).The general conditions of the two groups,especially coma assessment,laboratory test indicators,imaging examinations,suspected causes of coma at admission and treatment options were statistically analyzed.Logistic regression model was used for multivariate analysis.Results: There were 54 cases in plasma exchange group and 57 cases in non-plasma exchange group.There were significant differences between the two groups in age,weight at admission,Glasgow score at admission,respiratory and cardiac arrest before coma,and fever days before coma(P < 0.05),and no statistically significant differences in gender,Glasgow score during coma,pupil condition,central respiratory failure,and seizures(P > 0.05).The increase of cerebrospinal fluid protein level was statistically different(P < 0.05).There were significant differences in whole blood platelet count,procalcitonin,alanine aminotransferase,aspartate aminotransferase,creatinine and urea within 4 hours before and after coma(P < 0.05).In terms of head CT abnormalities within 24 hours of admission and head MRI abnormalities within 96 hours of admission,there were more cases in the plasma exchange group than in the non-plasma exchange group.There were 7 cases with abnormal CT findings and multiple low-density shadows,including 2 cases of symmetrical lesions,and 5 cases of demyelinating lesions suggested by head MRI,which were all from the plasma exchange group.The brainstem lesions in the plasma exchange group(6 cases)were significantly more than those in the non-plasma exchange group(1 case).The cases of hormone therapy in the plasma exchange group was more than that in the non-plasma exchange group,and the difference was statistically significant(P < 0.05).Binary Logistic regression analysis was used to evaluate the relationship between the selected independent variables and whether plasma exchange was performed.Among the independent variables included in the model,age(OR = 1.015,OR 95% confidence interval 1.004-1.026,P = 0.006)and fever before coma(OR = 4.87,OR 95% confidence interval 1.571-15.101,P = 0.006)were statistically significant(P < 0.05),which were independent risk factors for plasma exchange.Admission tendency to consider the immune mechanism involved in brain injury disease,combined with liver and kidney.Conclusion: Children with acute non-traumatic deep coma with progressive aggravation of disturbance of consciousness,infection,severe brain injury related to immune mechanism and liver and kidney damage are more likely to consider plasma exchange.