ABSTRACT
Introducción. En niños con sepsis, la sobrecarga hidrica como resultado de una terapia de resucitación agresiva o por la administración excesiva de fluidos puede afectar la función renal y aumentar la mortalidad. Objetivo. Determinar la asociación entre la sobrecarga hidrica y la tasa de falla renal en un grupo de niños con sepsis grave y shock séptico. Población y métodos. Estudio de cohortes prospectivo realizado en la Unidad de Cuidados Intensivos del Hospital Universitario de Pediatría "Dr. Agustín Zubillaga" (Barquisimeto, Estado Lara, Venezuela), entre marzo de 2013 y mayo de 2016, en niños con sepsis grave o shock séptico. Resultados. Un total de 149 niños fueron incluidos en el análisis. La sepsis predominó en el 59,7% de los casos; el promedio de edad fue 6,4 ± 3,3 años; el peso promedio fue 17,8 ± 3,6 kg; en el 30,2%, hubo sobrecarga hidrica y la mortalidad general fue 25,5%. Hubo falla renal en el 16,1% de los casos. Mediante un modelo de regresión logística binaria, se identificaron como predictores independientes de falla renal sobrecarga hidrica (OR 1,5; IC 95%: 1,2-4,9; p= 0,028) y shock mayor de dos días (OR 1,7; IC 95%: 1,3-6,3; p= 0,039). Además, se observó un incremento significativo del riesgo de mortalidad en los niños con falla renal y sobrecarga hidrica, según el método de Kaplan-Meier (p= 0,019). Conclusión. La sobrecarga hidrica y una duración del shock mayor de dos dias incrementan el riesgo de falla renal en niños criticamente enfermos con sepsis grave y shock séptico.
Introduction. In children with sepsis, fluid overload as a result of an aggressive fluid replacement or excessive fluid administration may result in kidney impairment and increased mortality.Objective. To determine the association between fluid overload and the rate of kidney failure in a group of children with severe sepsis and septicshock. Population and methods. This was a prospective cohort study conducted in the intensive care unit of Hospital Universitario de Pediatría Dr. Agustín Zubillaga (Barquisimeto, Lara State, Venezuela), between March 2013 and May 2016, in children with severe sepsis or septic shock.Results. One hundred and forty-nine patients were included in the analysis. Sepsis predominated in 59.7% of cases; patients' average age was 6.4 ± 3.3 years old, their average weight was 17.8 ± 3.6 kg, 30.2% had fluid overload, and overall mortality was 25.5%. Kidney failure occurred in 16.1% of cases. A binary logistic regression model was used to identify fluid overload (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-4.9, p = 0.028) and shock for more than 2 days (OR: 1.7; 95% CI: 1.3-6.3, p = 0.039) as independent predictors of kidney failure. In addition, a significant increase in the risk of mortality among children with kidney failure and fluid overload was observed as per the Kaplan-Meier method (p= 0.019). Conclusion. Fluid overload and shock for more than 2 days increase the risk for kidney failure in critically ill children with severe sepsis and septic shock.
Subject(s)
Humans , Child, Preschool , Child , Sepsis/therapy , Renal Insufficiency/etiology , Fluid Therapy/adverse effects , Shock, Septic/therapy , Cohort Studies , Renal Insufficiency/epidemiology , Fluid Therapy/methodsABSTRACT
INTRODUCTION: In children with sepsis, fluid overload as a result of an aggressive fluid replacement or excessive fluid administration may result in kidney impairment and increased mortality.Objective. To determine the association between fluid overload and the rate of kidney failure in a group of children with severe sepsis and septic shock. POPULATION AND METHODS: This was a prospective cohort study conducted in the intensive care unit of Hospital Universitario de Pediatría "Dr. Agustín Zubillaga" (Barquisimeto, Lara State, Venezuela), between March 2013 and May 2016, in children with severe sepsis or septic shock. RESULTS: One hundred and forty-nine patients were included in the analysis. Sepsis predominated in 59.7% of cases; patients' average age was 6.4 ± 3.3 years old, their average weight was 17.8 ± 3.6 kg, 30.2% had fluid overload, and overall mortality was 25.5%. Kidney failure occurred in 16.1% of cases. A binary logistic regression model was used to identify fluid overload (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-4.9, p = 0.028) and shock for more than 2 days (OR: 1.7; 95% CI: 1.3-6.3, p = 0.039) as independent predictors of kidney failure. In addition, a significant increase in the risk of mortality among children with kidney failure and fluid overload was observed as per the Kaplan-Meier method (p= 0.019). CONCLUSION: Fluid overload and shock for more than 2 days increase the risk for kidney failure in critically ill children with severe sepsis and septic shock.
En niños con sepsis, la sobrecarga hídrica como resultado de una terapia de resucitación agresiva o por la administración excesiva de fluidos puede afectar la función renal y aumentar la mortalidad.
Subject(s)
Fluid Therapy/adverse effects , Renal Insufficiency/etiology , Sepsis/therapy , Child , Cohort Studies , Female , Fluid Therapy/methods , Humans , Male , Renal Insufficiency/epidemiology , Shock, Septic/therapyABSTRACT
UNLABELLED: Although the transfusionofblood products is common practice, its effects on the immune system have not been adequately studied. A prospective cohort study was conducted in critically ill children followed up until their death, transfer or discharge to establish an association between red blood cell transfusions (RBCTs) and nosocomial infections. A nosocomial infection was considered to be post-transfusional if it occurred within 14 days after RBCT. A total of 162 children were included in the study, 35 (21.6%) had a nosocomial infection, and 49 (30.2%) received a RBCT. Among those with a nosocomial infection, a RBCT was more common (48.5% versus 14.9%, OR: 5.4, 95% CI: 2.412.6, p ã 0.0001) and mortality rate was higher (45.7% versus 10.2%, OR: 7.4, 95% CI: 3.1-18.2, p ã 0.0001). The binary logistic regression showed that RBCT was independently associated with nosocomial infections (OR: 4.2, 95% CI: 2.1-20.2, p = 0.049). CONCLUSION: RBCT was associated with increased risk for nosocomial infections.
Aunque la transfusión de hemoderivados es una práctica común, los efectos sobre el sistema inmune no han sido bien estudiados. Para determinar la asociación entre transfusión de glóbulos rojos (TGR) e infecciones nosocomiales, se realizó un estudio de cohorte prospectivo con niños críticamente enfermos, seguidos hasta su fallecimiento, transferencia o egreso. Las infecciones nosocomiales se consideraron postransfusionales si ocurrieron dentro de los 14 días después de la TGR. Se incluyeron 162 niños, 35 adquirieron infección nosocomial (21,6%) y 49 recibieron TGR (30,2%). Los niños con infección nosocomial recibieron más frecuentemente TGR (48,5% vs. 14,9%; OR 5,4; IC 95%: 2,4-12,6; p ã 0,0001) y presentaron mayor mortalidad (45,7% vs. 10,2%; OR 7,4; IC 95%: 3,1-18,2; p ã 0,0001). En la regresión logística binaria, la TGR se mantuvo asociada independientemente a infección nosocomial (OR 4,2; IC 95%: 2,1-20,2; p = 0,049). Conclusión: La TGR se asoció a un incremento del riesgo de adquirir infecciones nosocomiales.
