Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study.

Autor: Hauschild DB; Nutrition Department, Federal University of Santa Catarina, Florianópolis, Brazil., Oliveira LDA; Federal University of Santa Catarina, Florianópolis, Brazil., Ventura JC; Federal University of Santa Catarina, Florianópolis, Brazil., Farias MS; Nutrition, Joana de Gusmão Children's Hospital, Florianópolis, Brazil., Barbosa E; Nutrition, Joana de Gusmão Children's Hospital, Florianópolis, Brazil., Bresolin NL; Pediatric Intensive Care Unit, Joana de Gusmão Children's Hospital, Florianópolis, Brazil., Moreno YMF; Federal University of Santa Catarina, Florianópolis, Brazil.
Jazyk: angličtina
Zdroj: Journal of human nutrition and dietetics : the official journal of the British Dietetic Association [J Hum Nutr Diet] 2021 Apr; Vol. 34 (2), pp. 365-373. Date of Electronic Publication: 2020 Aug 07.
DOI: 10.1111/jhn.12798
Abstrakt: Background: Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS-ped) and to verify its association with clinical outcomes.
Methods: A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS-ped, based on adult definition, was described. PICS-ped was defined as PICU length of stay >14 days; C-reactive protein > 10.0 mg L -1 ; lymphocytes <25%; and any reduction of mid-upper arm circumference Z-score. Clinical, demographic, nutritional status, nutrition therapy parameters and clinical outcomes were assessed. Statistical analysis comprised Mann-Whitney and Fisher's chi-squared tests, as well as logistic and Cox regression. P < 0.05 was considered statistically significant.
Results: In total, 153 children were included, with a median age of 51.7 months (interquartile range 15.6-123.4 months), and 60.8% male. The mortality rate was 10.5%. The prevalence of PICS-ped was 4.6%. Days using vasoactive drugs and days using antibiotics were associated with PICS-ped. PICS-ped was associated with mortality in crude (odds ratio = 6.67; P = 0.013) and adjusted analysis (odds ratio = 7.14; P = 0.017). PICS-ped was also associated with PICU and hospital length of stay, as well as duration of mechanical ventilation. Similar results were found in a subset of critically ill children who required mechanical ventilation for more than 48 h.
Conclusions: Children with PICS-ped required antibiotics or vasoactive drugs for a longer period. PICS-ped was associated with poor clinical outcomes in critically ill children. More studies are needed to properly define PICS-ped for this population.
(© 2020 The British Dietetic Association Ltd.)
Databáze: MEDLINE
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