Comparison of Predictive Powers for Mortality between Systemic Vascular Resistance Index and Serum Lactate in Children with Persistent Catecholamine-Resistant Shock.

En-Pei Lee,Kuan-Fu Chen,Shao-Hsuan Hsia,Ya-Ting Su,Han-Ping Wu,Oi-Wa Chan,Sheng-Chih Chu,Chia-Ying Lin,Jainn-Jim Lin

doi:10.1155/2020/1341326

Abstract

Persistent catecholamine-resistant shock in children causes severe morbidity and mortality. We aimed to analyze the association between hemodynamics and serum lactate at different time points and 28-day mortality in children with persistent catecholamine-resistant shock. Methods. Twenty-six children with persistent catecholamine-resistant shock were enrolled, and their hemodynamics were monitored using the pulse index continuous cardiac output. Serial cardiac index (CI), systemic vascular resistant index (SVRI), and vasoactive-inotropic score (VIS) were analyzed for the first 24 hours. Associations between hemodynamics, serum lactate, and 28-day mortality were analyzed. Results. The 28-day mortality rate was 53.8%. SVRI and VIS were independent predictors of 28-day mortality. The mortality group had lower serial SVRI and higher VIS than the survival group (p < 0.05). Serial SVRI had the highest area under the receiver operating characteristic curve (AUC) for predicting mortality during the first 24 hours of persistent catecholamine-resistant shock. Three important hemodynamic parameters, CI, SVRI and perfusion pressure (MAP-CVP), were significantly correlated with lactate, of which SVRI had the best correlation (r = −0.711, p < 0.001). According to the AUC, SVRI was a more powerful predictor of mortality than lactate in persistent catecholamine-resistant shock. After 24 hours of treatment for persistent catecholamine-resistant shock, an SVRI lower than 1284 dyn·s·cm−5·m2 was associated with 28-day mortality. Conclusions. SVRI was an early factor associated with mortality in the pediatric patients with persistent catecholamine-resistant shock potentially and had the good correlation with serum lactate. An SVRI more than 1284 dyn·s·cm−5·m2 during the first 24 hours of persistent catecholamine-resistant shock was associated with favorable outcomes. The result should be used with caution due to the small sample size.

Highlights

Pediatric severe sepsis remains an important public health issue, with the similar rates of incidence, morbidity, and mortality comparing to critically ill adult populations [1]
Patients were included in the study if they were diagnosed with sepsis complicated with persistent catecholamine-resistant shock, and their hemodynamics were monitored via a pulse index continuous cardiac output system (PiCCO, PULSION Medical Systems, Munich, Germany)
In this 10year retrospective study, we found that systemic vascular resistant index (SVRI) was an early factor associated with mortality in pediatric patients with persistent catecholamine-resistant shock potentially and that it had a good correlation with serum lactate

Summary

Introduction

Pediatric severe sepsis remains an important public health issue, with the similar rates of incidence, morbidity, and mortality comparing to critically ill adult populations [1]. Severe sepsis accounted for >8% of all critically ill children and caused more than 4.5 million childhood deaths every year worldwide [1, 2]. Persistent catecholamine-resistant shock is the most serious form of sepsis and is defined as hypotension with endorgan dysfunction after fluid resuscitation and vasopressor therapy, with a very high mortality rate of about 60% [3,4,5]. Previous studies have shown that persistent abnormal hemodynamics such as lower cardiac index (CI) and systemic vascular resistant index (SVRI) are associated with increasing mortality in pediatric patients with septic shock [7,8,9,10]. Ceneviva et al reported that optimal CI and SVRI were associated with a better prognosis in children with persistent catecholamine-resistant shock [11]

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