Risk Factors For Severe Pneumonia With Sepsis In Children With PICU

ObjectiveTo analyze the clinical data of children with Community-acquired severe pneumonia complicated with sepsis by PICU in Jiangxi Children's Hospital in recent5 years,and to explore the risk factors of Community-acquired severe pneumonia complicated with sepsis in children.MethodsUsing retrospective study method,we choosed people a total of 382children who community-acquired severe pneumonia in the Jiangxi province Children's Hospital pediatric intensive care unit?PICU?from January 10,2014 to November 01,2019 as the research object and we divided these samples into two groups:87 cases of severe pneumonia complicated with sepsis were included in the sepsis group,and 87 cases of severe pneumonia matched with the gender and age of the sepsis group were randomly selected to be included in the non-sepsis group.Clinical medical records of children in the two groups?such as general conditions,PCIS score,basic diseases,blood routine,blood gas analysis,liver and kidney function and other indicators?were recorded for single-factor and multi-factor risk factor analysis.It's considered statistically significant when P<0.05.Results1.The median age of 174 cases was 5 months?2 to 6months?,and the proportion of severe pneumonia was 71.8%.2.The median length of hospital stay in 174 patients was 12 days?5 to 23daays?,and the length of hospital stay in the sepsis group?10 days,3 to 22 days?was lower than that in the no-sepsis group?13 days,9 to 23 days,P=0.02?.3.The case fatality rate in the sepsis group?43.7%?was higher than that in the non-sepsis group?15.0%,P=0.001?.4.Among the 174 cases,116?66.8%?were associated with underlying diseases,most of which were congenital heart disease?113 cases,97.4%?.Among them,congenital heart disease?83.9%vs.46.0%,P=0.001?and hematologic tumor disease?11.5%vs.1.1%,P=0.005?were significantly higher in the sepsis group than in the non-sepsis group.5.A total of 39 cases?22.4%?were positive in 174 blood cultures,mainly staphylococcus?43.2%?.Bacterial infection in the sepsis group?42.5%?was higher than that in the non-sepsis group?11.5%,P=0.001?.Among the 90 patients?51.7%?with positive virus test,respiratory syncytial virus?27.8%?were more common.The virus infection in the non-sepsis group?62.1%?was higher than that in the sepsis group?41.1%,P=0.006?.There were 41 cases of mixed pathogen infection?35.7%?,most of which were mixed infection of bacteria and virus?46.3%?,and the mixed infection of sepsis group?31.0%?was higher than that of non-sepsis group?16.1%,P=0.02?.6.Among the 174 children,156?89.7%?had complications,mainly including respiratory failure?152 cases,97.4%?.Heart failure,renal failure,liver failure,brain failure,severe coagulation dysfunction,severe electrolyte disorder,serous cavity effusion were higher in sepsis group than in non sepsis group?P<0.05?.7.Single-factor risk factor analysis suggested that PCIS score,congenital heart disease,hematologic tumor disease,bacterial infection,virus infection,mixed infection,WBC,HB,PLT,ALB,TBIL,BUN,AST,K+,PCT,PaO₂,Cr and CRP were suspected risk factors for sepsis in severe pneumonia?P<0.05?.8.By multi-factor analysis,the results showed that congenital heart disease,bacterial infection,mixed infection,increased WBC,increased AST,decreased PO₂and decreased PLT were independent risk factors for severe pneumonia with sepsis?P<0.05?.Conclusions1.Infants are at high risk of severe pneumonia.2.The sepsis group was dominated by bacterial infection and mixed infection,and staphylococcal infection and mixed infection of bacteria and virus were more common.3.Congenital heart disease,bacterial infection,mixed infection,increased WBC,increased AST,decreased PO₂,and decreased PLT are independent risk factors for severe pneumonia with sepsis.4.In children with severe pneumonia complicated with sepsis,the disease progresses rapidly and is prone to organ failure,High fatality rate and poor prognosis.