The Clinical Characteristics And Analysis Of Death’s Risk Factors In Pediatric Septic Shock

Objective:To understand the clinical characteristics and to explore the death risks of septic shock in children for a better understanding of its early clinical stage so as to improve the success rate of septic shock.Methods:Clinical data of83confirmed cases with septic shock who were hospitalized in the Pediatric Intensive Care Unit of the First Affiliated Hospital of Guangxi Medical University from March2006to December2011were collected. Data comprises of the ages, genders, clinical manifestations as well as laboratory informations of blood chemistries like white blood cell(WBC) count, hemoglobin(HGB) concentration,platelet (PLT)count, serum total protein (TP)concentration, serum albumin protein (ALB) concentration, arterial blood gas analysis, C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), glucose. In addition, bacterial endotoxin, serum (1â†'3)βD glucan, microbiologic etiology, site of infection, underlying primary diseases, the number of dysfunctional organ, mechanical ventilation, time of fluid resuscitation and so on were also recorded. Based on the statistical analysis we could:1) find the clinical summary of pediatric septic shock characteristics, and2) investigate the death risk factors of pediatric septic shock.Results:1. Of all the83cases, the total mortality rate was32.5%, the incidence of multiple organ dysfunction(MODS) was74.5%, whereas mortality rate in patients with MODS and septic shock was59.09%and in of all the dysfunctional organs, the lung was most often damaged.2. The incidence of hypotension for septic shock in the death group is higher than the non-death group, and the difference is statistically significant.3. Among primary diseases, hematological disease was accounted as the most common, with40.96%, during which septic shock occurs and consequently was also the main cause of death too; letting other disease like pneumonia, congenital abnormalities in digestive orgons to follows as second and third place respectively.4. Time taken of liquid resuscitation in the death group was longer than that in the non-fatal group(P<0.05) and the duration of shock in the death group was significantly higher than that in the non-fatal one.5. Positive rates of pathogen culture was significantly higher in the death group than that in non-death group (P<0.05).6. Univariate analysis revealed that the four factors, namely, long resuscitation times, arterial blood gas with PH<7.35, multiple organ dysfunction and positive pathogen culture were the main death risk factors of septic shock. Others like age, gender, duration of hospitalization, hypotension,WBC and neutrophil count, HGB, PLT, CRP,TP,ALB,BE, ESR, blood glucose, bacterial endotoxin, serum (1â†'3)β-D glucan, mechanical ventilation were not associated with death in pediatric septic shock. Multivariate logistic regression analysis showed no significant association between the four main death risk factors of septic shock (P>0.05).Conclusion:1. Mortality in pediatric septic shock was high, and early identification and promptly resuscitation of septic shock can help to reduce mortality rates.2. Univariate analysis revealed that long time of drugs resuscitation, PH of arterial blood gas<7.35, complications like multiple organ dysfunction and positive pathogen culture were the most important death risk factors of septic shock.3. The key to reduce incidence and mortality of septic shock is to strengthen the prevention of nosocomial infection.4. Early identification clue such as underlying primary diseases and microcirculation dysfunction has more guidance significance.