Clinical Features And Risk Factors Associated With The Death Of Sever Sepsis In Children

Objective：Critical medicine focus on the diagnosis and treatment ofpediatric severe sepsis. To investigate clinical features and risk factorsassociated with the death of severe sepsis in children for decreasingmortality and improving prognosis.Methods： From15thnovember2010to15thnovember2013,50cases were selected from Pediatric Intensive Care Unit of children`shospital affiliated of Chongqing Medical University，according to thedefinitions of Severe sepsis.Variables such as clinical signs，complicationand therapeutic approaches were included as the research factors todescribe the clinical feathers and analyzed both by univariate analysis andlogistic analysis by SPSS to investigate the risk factors.Results：（1）Children admitted to our PICU in the three years reached1032，50cases develop severe sepsis，the incidence is4.84%，the infant take62%.25cases （50%） caused by respiratory infection.The mainpathogen is bacteria，Gram-negative bacteria happen more ofen.（2）Ittakes5.5days to diagnose.80percent of patients got fever，lasting for4days. Mean PCIS of48cases is77.13.Nearly half the patients gotthrombocytopenia，more than a half children got Hypoproteinemia andlactate increase.(3)47patients got antibiotics therapy immediately，33cases（66%）used Carbapenem antibiotics.15patients get steroid therapy.40patients complicated aute respiratory failure manipulate mechanicalventilation.19of28shock patients(67.86%) got fluid resuscitation andinotropic/vasopresser support.（4）18of50patients died, the mortality was36％.16cases （50%）complicated ARDS/ALI of whom8died.50percentof28shock patients died.MODS happened in47cases，the mortality ofdysfunctional organ less than3、more than3is20.59%、68.75%. The PCISis negatively correlated(r=-0.54，P<0.01) with the mortality，otherwise，the level of lactate（r=0.58，P<0.01） and number of dysfunctional organ（r=0.41，P<0.01）are positive correlated with the death of severe sepsis.Conclusion：severe sepsis is often seen in PICU（the infant happen alot）and its mortality is high. Respiratory infection cause severe sepsismore often. Pneumonia is a common cause.The main pathogen is bacteria，Gram-negative bacteria take the main place.Lactate increase、MODS、low PCIS are risk factors for severe sepsis.