Comparación de índices de riesgo de mortalidad en pacientes pediátricos con choque séptico

Abstract

IntroductionSeptic shock is one of the main causes of morbidity and mortality in paediatrics, with a mortality ranging from 28-50%. Therefore, more and more tools for assessing the gravity are used to objectively quantify the clinical situation of the patient. Many of them have multiple scales, as well as not applicable in all hospital settings. ObjectiveTo compare the mortality rates using the Paediatric Risk of Mortality score (PRISM), Paediatric Mortality Index (PMI), and inotropic score in patients with septic shock. Material and methodsA prospective, cross-sectional study was performed that included patients admitted to the intensive care unit with the diagnosis of septic shock based on the definition of the International Sepsis Conference. This classified it as: severe sepsis and cardiac dysfunction (after loading 40ml/kg; hypotension present and/or requiring inotropic support, or two or more of the following: metabolic acidosis, hyperlactataemia, oliguria, capillary filling greater than 5s, difference between central and peripheral temperature greater than 3°C). Patients included were older than 1 month and younger than 18 years and those who required inotropic support within 48h after arrival in the paediatric intensive care unit. The indexes of the PRISM II (which evaluates age, blood pressure, heart rate, respiratory rate, PaO2/FiO2, PCO2, bilirubin, calcium, potassium, blood glucose, bicarbonate, Glasgow score); In addition to the PMI II, which evaluates whether the admission is scheduled, use of cardiac bypass, diagnosis, pupil response, mechanical ventilation in the first hour, systolic blood pressure, base excess and FiO2/PaO2, and Inotropic score at 6 and 24h post-admission, which was calculated according to Wernovsky's formula (dopamine dose [μg/kg/min]+dobutamine dose [μg/kg/min]+adrenaline dose [μg/kg/min]×100+dose of milrinone [μg/kg/min]×10+doses of vasopressin [U/kg/min]×10,000+doses of noradrenaline [μg/kg/min]×100). The exclusion criteria were: admission to the neonatal intensive care unit, age less than 30 days or greater than 18 years, and the need for a procedure in the operating room within the first 6h after admission. ResultsA total of 47 patients were admitted, of whom 59.7% (n=28) were male. The overall mortality was 42.6% (n=20). Mortality indices obtained in the first 6h included inotropic score 42.2 (5-300), PMI II 51.7% (2-99.6%), PRISM II 58% (1.5-100%). Mortality was associated with a different area under the curve (AUC) of 0.891 (95% CI; 0.788-0.995), PMI II sensitivity 70%, specificity of 66.7%, AUC 0.808 (95% CI; 0.677-0.938), PRISM II sensitivity 75%, specificity 59.3%, with AUC 0.801 (95% CI; 0.665-0.931). ConclusionsThe inotropic score has a high association with mortality in patients with septic shock. This is an easily accessible tool and does not require special training for health personnel, so it could be a useful substitute in the assessment of these patients.