Navegando por Palavras-chave "Septic Shock"

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    Análise do perfil clínico e de sobrevivência de pacientes pediátricos com câncer com choque séptico
    (Universidade Federal de São Paulo (UNIFESP), 2021) Azevedo, Rafael Teixeira [UNIFESP]; Petrilli, Antonio Sergio [UNIFESP]; Universidade Federal de São Paulo
    Objectives: To describe the clinical characteristics and to evaluate the risk factors related to mortality and survival of pediatric cancer patients admitted to the Pediatric Intensive Care Unit (PICU) for septic shock. Methods: Retrospective cohort study. Pediatric patients up to 18 years of age, followed at the GRAACC-IOP for oncologic diagnosis and admitted to the PICU in the last 5 years during a septic shock, were included. For the evaluation of organ dysfunctions, definitions from the Latin American Institute of Sepsis were used. Variables were described as medians and interquartile ranges, or means and standard deviations. The significance value was p < 0.05. Differences between means were evaluated by the T test. Survival analysis over the days of hospitalization was performed using Kaplan-Meier curves, with comparisons by the Log Rank test (Mantel-Cox), and proportional hazard estimates by Cox regression. The analyzes were performed with the packages survival, pROC, tidyverse, caret, glmnet, dplyr and survminer, from the R software version 4.1.1. Results: 139 patients were included. The median age was 99 months and 50.3% were female. There was a mortality of 57 patients (41%) and 10 children (7.2%) died within 24 hours of septic shock. Twenty-three patients (16.5%) had Acute Lymphoid Leukemia and 42 (30.2%) had relapsed disease. Thirty-nine patients (28%) had undergone hematopoietic stem cell transplantation. The patients had a median of 21 days of hospital stay, with a median of 10 days in the PICU. 33.8% of patients had a catheter-associated bloodstream infection. The most common agents were Klebsiella pneumoniae and Escherichia coli. Norepinephrine and epinephrine were the main drugs of first choice in septic shock (77.7%). The vasoactive-inotropic score (VIS) averaged 34.6 points. A positive fluid balance between 20 and 60 mL/kg (2% to 6% of body weight) in the first 24 hours after the diagnosis of sepsis showed a reducing effect on the probability of in-hospital death (Hazard ratio 0.47, 95% CI 0.24-0.92, p = 0.027) regardless of clinical severity. The number of organ dysfunctions (p < 0.0001), the presence of relapsed disease (p < 0.0001), the presence of respiratory dysfunction (p = 0.04), the need for continuous renal replacement therapy (p = 0.029), VIS (p = 0.009) and PRISM-IV (p < 0.0001) were predictors of mortality. Conclusion: Our study demonstrates the complexity of the pediatric cancer patient with septic shock in the PICU. We highlighted the importance of bloodstream infection as a focus of infection, the need of interrupting the progression of sepsis to septic shock and consequent multiple organ dysfunction, which is the main cause of mortality, and the role of the managed sepsis protocol in this purpose. We also showed a lower mortality in patients with positive fluid balance between 2% and 6% of body weight in the first 24 hours after the sepsis diagnostic and the possibility of considering this information in the sepsis protocol.