Effect Of Clinical Status On Prognosis Of Children With Complicated With Sepsis When Transferred To The PICU

ObjectiveTo investigate the effect of clinical status on prognosis of children with acute leukemia complicated with sepsis when transferred to PICU node and to compare the predictive value of different scoring systems for the outcome of acute leukemia with sepsis when transferred into PICU.MethodsFrom March 2013 to June 2019,a total of 51 children were transferred to the pediatric intensive care unit(PICU)due to acute leukemia(including acute lymphoblastic leukemia and acute myeloid leukemia)complicated with sepsis in the pediatric hematology department of Zhu jiang hospital of Southern Medical University during the course of chemotherapy,with complete clinical data.According to the outcome of children in PICU,they were divided into survival group and death group.Collect of two groups of children to PICU vital signs,clinical features,laboratory index etc.Retrospectively evaluate the PSOFA(Pediatric Sequential Organ Failure score),PSOFAchange,PEWS(Pediatric Early Warning score),qSOFA(quick SOFA)score in two groups when they transferred into PICU and make four scoring system the receiver-operating characteristic curve(ROC),and the area under ROC(AUROC)statistical analysis,and then compare the prediction efficiency for sepsis leads to death.ResultsA total of 51 cases with acute leukemia with sepsis to PICU,survival group of 22 cases,death group 29 cases,mortality is 56.9%,the single factor analysis showed that:there is no statistical difference in gender,age,diagnosis,duration of neutropenia,fever duration,site of infection,pathogens,neutrophil count,lactic acid.CRP(C-reactive protein),platelet count,albumin,blood bilirubin.Remission status,fibrinogen,length of hospital stay,blood creatinine,heart rate,and changes in consciousness were statistically different between the survival group and the death group.The mean value of PSOFA,PEWS and qSOFA scores in the death group was higher than that in the survival group,with statistical differences between the two groups.The AUROC of the PEWS score was significantly higher than that of the other three scoring systems,and there was no statistical difference between the AUROC of the other three scoring systems.ConclusionThe mortality of children with acute leukemia complicated with sepsis when transferred to PICU is high.Leukemia not alleviated,length of hospital stay>14 days,the heart rate increased,reduced fibrinogen,altered level of consciousness,and elevated serum creatinine are the risk factors of death is of acute leukemia patients complicated with sepsis.PEWS scores performed the best in predicting the mortality of children.The optimal cut-off value for PEWS to predict death was 5.5 points.