| ObjectivesTo explore the clinical features,laboratory indicators and prognostic factors of critical children with capillary leak syndrome.Methods1.Research objects:This study is a retrospective study.658 critically ill children aged 0-18 years were selected from the Hospital of the Department of Intensive Care Unit of the Children's Hospital Affiliated to the Capital Institute of Pediatrics from October 1,2015 to October 30,2018.According to the inclusion criteria and exclusion criteria,46 critically ill children with capillary leak syndrome(CLS)were enrolled.2.Collection of data:general situation,clinical manifestations,auxiliary examinations,treatment measures and prognosis of children;3.Study grouping:The children were divided into survival group and death group according to the outcome at discharge/28-day prognosis.According to the progress of CLS,the children were divided into early stage(1-3 days),middle stage(4-6 days)and late stage(7-9 days).According to the study of early liquid treatment components,it is divided into crystal liquid group,albumin group,albumin+colloidal body fluid group.4.To study the clinical characteristics and laboratory examination evolution of capillary leak syndrome according to clinical data.5.To analyze the prognostic factors of capillary leak syndrome.Results1.Distribution of CLS in children as a whole(1)This study included 46 cases of CLS from 658 critically ill children,with an incidence rate of 6.99%,30 males and 16 females,the age of onset was 5.5(0.23,24.75)months,including 17 newborns(36.96%).There were 18 deaths in acute stage,the mortality was 39.13%.(2)Distribution of primary diseases in children with CLS:sepsis in 29 cases(63%),cardiothoracic and abdominal surgery in 8 cases(17%),ARDS in 3 cases(7%),hematopoietic stem cell transplantation in 3 cases(7%),Baliximab injection?poisoning and heat stroke in 1 case(2.17%).(3)Clinical manifestations:1)The onset time of CLS was 2(1,4)days;typical systemic soft tissue edema in 22 cases(47.83%),the duration of CLS was(5.15+2.86)days;Peritoneal effusion in 9 cases(19.57%),Pleural effusion in 6 cases(13.04%),Pericardial effusion in 1 case(2.17%),and Compartment syndrome in 2 cases(4.35%);HCT was(34.55%+10.94%),serum albumin was 25.85(21.35,27.3)g/L;2)Complications:There were 30 cases of MODS(65.22%),13 cases of acute Pulmonary edema(28.26%),13 cases of acute kidney injury(28.26%),12 cases of DIC(26.09%),9 cases of intractable hypernatremia(19.57%)in the course of the disease,and 4 cases(8.7%)of blood Pressure fluctuation in the later stage of the disease.3)Mortality:8 cases(44.44%),2 cases(11.11%)and 8 cases(44.44%)died in the early,middle and late stages of CLS.Among the causes of death,10 cases(55.56%)were MODS,5 cases(27.78%)were shock,and 3 cases(16.67%)were acute pulmonary edema.4)Treatment:42 cases(91.3%)were treated with antibiotics,27 cases(58.69%)were treated with invasive mechanical ventilation,26 cases(56.52%)were treated with more than two Vascular active drugs,29 cases(63.04%)were transfused with human albumin,9 cases(13.04%)were treated with artificial colloid,16 cases(34:78%)were transfused with plasma,erythrocyte and platelet,and 10 cases(21.78%)were treated with human immunoglobulin,18 cases(39.13%)received glucocorticoid and 9 cases(19.57%)received CRRT.2.Comparison of clinical indicators between survival and death groups in the early,middle and late stages of the study:The tissue perfusion indexes of both groups were lower and needed positive liquid balance,but there was no difference between the two groups(P>0.05).The albumin(Alb)of death group was lower than that of survival group(22.22g/L vs 26.lg/L,P<0.05),and the capillary leak index(CLI=CRP/Alb)of death group was higher than that of survival group(2.06 vs 0.7,P<0.05).The levels of PCT(9.lng/ml vs 0.5ng/ml)and BNP(12203pg/ml vs 610pg/ml)were higher than those of survival group(P<0.05),and the oxygenation index was lower than that of survival group(152mmHg vs 219mmHg,P<0.05).On the 6th day of CLS course,the survival group entered negative liquid balance,while the death group continued positive liquid balance(P<0.05).There was no difference in albumin and CLI between the two groups(P>0.05);CRP in the late death group was significantly higher than that in the survival group(92 mg/dL vs 8 mg/dL,P<0.05),CLI increased(0.31 vs 2.28),lactic acid increased(2.68 mmol/L vs 1.85 mmol/L)and oxygenation index decreased(164 mmHg vs 203 mmHg),with statistical significance(P<0.05).3.The results of different kinds of fluid in the early stage of CLS were compared:there was no difference of albumin elevation in the middle stage in the crystalloid group,albumin group and albumin combined with artificial colloid group(P>0.05),and the duration of leak was no difference between three groups(P>0.05).There was no difference in renal function before and after the application of hydroxyethyl starch(P>0.05),and there was no decrease in platelet count(P>0.05).4.Analysis of Prognostic Factors(l)Multivariate logistic regression analysis showed that conventional treatment had no direct impact on the outcome of children.(2)The laboratory indices,NCIS/PCIS scores and the number of organ dysfunction in children with CLS were analyzed by single factor analysis between the two groups,CLI?Glucose?albumin,lactic acid?NCIS/PCIS score and organ dysfunction(more than three)(P<0.05)were found to be different between the two groups in early stage,BNP?oxygenation index were found to be different between the two groups in middle stage.Logistic regression analysis showed that NCIS/PCIS score and the number of organ dysfunction(more than three)affected the Prognosis of the children.Conclusions1.The incidence of CLS in ICU was 6.99%,the predisposing age was under 1 year old,and the mortality in acute phase was 39.13%.2.Sepsis is the most common primary disease,accounting for 63%.3.There is no difference between albumin and artificial colloid solution in improving capillary permeability.4.NCIS/PCIS score,number of organ dysfunction(more than three)and mid-course oxygenation index impacts the prognostic. |
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