Early predictors of refractory septic shock in neonates
10.3760/cma.j.issn.2096-2932.2024.03.006
- VernacularTitle:新生儿难治性脓毒性休克早期预测指标分析
- Author:
Junjuan ZHONG
1
;
Jing MO
;
Jing ZHANG
;
Yingyi LIN
;
Dongju MA
;
Yue WANG
;
Chun SHUAI
;
Xiuzhen YE
Author Information
1. 广东省妇幼保健院新生儿科/广东省新生儿重症医学专业质量控制中心/国家临床重点专科建设项目单位，广州 510000
- Keywords:
Septic shock;
Refractory shock;
Mean arterial pressure/cardiac index ratio;
Septic shock score;
Neonate
- From:Chinese Journal of Neonatology
2024;39(3):157-161
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the early predictors of refractory septic shock (RSS) in neonates.Methods:From July 2020 to December 2021, clinical data of neonates with septic shock admitted to the Neonatal Department of our hospital were retrospectively reviewed. According to the maximum septic shock score (SSS) during clinical course, the neonates were assigned into RSS group and non-RSS group. Perinatal data, laboratory results and hemodynamic parameters at diagnosis were compared between the two groups. Multiple logistic regression analysis was used to identify independent risk factors of RSS and septic shock-related death. Receiver operating characteristic (ROC) curve was constructed to evaluate the early predictors of poor prognosis.Results:A total of 130 neonates were enrolled, including 54 in RSS group and 76 in non-RSS group. Compared with the non-RSS group, the RSS group had significantly lower pH, base excess (BE), stroke volume index (SVI), cardiac output (CO) and cardiac index (CI).Meanwhile, the RSS group had significantly higher mean arterial pressure (MAP) to CI ratio (MAP/CI) and SSS [including bedside SSS (bSSS), computed SSS (cSSS) and modified version of cSSS (mcSSS)] (all P<0.05). Multiple logistic regression analysis showed that increased MAP/CI was an independent predictor of RSS. The cut-off value of MAP/CI was 11.6 [sensitivity 62%, specificity 87%, positive predictive value (PPV) 79% and negative predictive value (NPV) 77%], with an area under the curve (AUC) of 0.734. Increased mcSSS was an independent predictor of septic shock-related death. The cut-off value of mcSSS was 5.8 (sensitivity 83%, specificity 72%, PPV 21% and NPV 97%), with an AUC of 0.845. Conclusions:Increased MAP/CI (≥11.6) and mcSSS (≥5.8) may be early predictors of RSS and septic shock-related death in neonates.
