Multiple-organ dysfunction in children with central nervous system infections

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Abstract

BACKGROUND: Multiple-organ dysfunction syndrome is one of the most dangerous complications of critical illness in children, which helps determine the disease outcomes.

AIM: This study aimed to examine the features of multiple-organ dysfunction syndrome in children with severe central nervous system (CNS) infection and identify factors that determine disease outcomes.

MATERIALS AND METHODS: This single-center, retrospective, observational study enrolled 98 patients, which included 66 (67%) boys and 32 (33%) girls. The average age was 3.6 ± 2.5 years. The Glasgow coma scale (GCS) score was 8.8 ± 2.4 points. Shock was diagnosed in 43 (44%) patients. The average treatment duration in the intensive care unit (ICU) was 9.5 ± 6.2 days, the duration of mechanical ventilation was 6.0 ± 3.9 days, and the mortality rate was 9%. Depending on the outcome, the children were divided into groups I (recovery, n = 88) and II (death, n = 10). All indicators were recorded in the first 12 h from ICU admission.

RESULTS: The most pronounced phenomena of cardiovascular dysfunction, such as decreased Teicholtz ejection fraction (62.3 L/min), were observed when the pSOFA scale score was >10 points, which was statistically significant when compared with the indicators in children with a pSOFA scale score of <8 points. In all patients, regardless of age, a negative correlation of moderate strength was found between the pSOFA scale score and the Teicholtz ejection fraction, and it was pronounced in children aged 7–17 years (R = –0.41; p = 0.008). A positive correlation was found between heart rate and pSOFA scale score in children aged 7–17 years (R = 0.72; p = 0.009). In the evaluation of the discriminatory ability of the pSOFA scale and Phoenix sepsis scores regarding the outcome on the first day of treatment in the ICU, the latter has greater prognostic significance (area under the curve, 0.866 vs 0.838; sensitivity, 76% vs 72%; specificity, 82% vs 79%).

CONCLUSIONS: Low cardiac output syndrome and systemic hypoxia are key factors associated with fatal outcomes in children with severe CNS infections. The high clinical significance of the ejection fraction in predicting the outcomes of severe CNS infections in children, regardless of age, allows the use of this parameter for goal-oriented therapy.

About the authors

Kseniya Yu. Ermolenko

Saint Petersburg State Pediatric Medical University; Children’s Research and Clinical Center for Infectious Diseases

Email: ksyu_astashenok@mail.ru
ORCID iD: 0000-0003-1628-1698
SPIN-code: 7584-8788
Russian Federation, Saint Petersburg; Saint Petersburg

Konstantin V. Pshenisnov

Children’s Research and Clinical Center for Infectious Diseases

Author for correspondence.
Email: Psh_K@mail.ru
ORCID iD: 0000-0003-1113-5296
SPIN-code: 8423-4294

Dr. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg

Yurii S. Aleksandrovich

Children’s Research and Clinical Center for Infectious Diseases

Email: jalex1963@mail.ru
ORCID iD: 0000-0002-2131-4813
SPIN-code: 2225-1630

Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Irina V. Aleksandrovich

North-Western State Medical University named after I. I. Mechnikov

Email: iralexzz15@bk.ru
ORCID iD: 0000-0003-1110-9848
SPIN-code: 9631-1989

Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Alexandr I. Konev

Saint Petersburg State Pediatric Medical University; Children’s Research and Clinical Center for Infectious Diseases

Email: icdrkonev@yandex.ru
ORCID iD: 0000-0002-0427-7344
SPIN-code: 7458-6203
Russian Federation, Saint Petersburg; Saint Petersburg

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Supplementary files

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2. Fig. 1. pSOFA scale score in the first 5 days of treatment in the intensive care unit depending on the disease outcomes

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3. Fig. 2. Involvement of organ systems in multiple-organ dysfunction syndrome in children with severe central nervous system infections

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4. Fig. 3. Structure of multiple-organ dysfunction in patients with fatal outcomes

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5. Fig. 4. Discriminatory ability of the pSOFA scale and Phoenix sepsis scores in predicting the outcomes of severe central nervous system infections in children

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