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Liu G, Zhang CM, Li Y, Sun JY, Cheng YB, Chen YP, Wang ZH, Ren H, Liu CF, Jin YP, Chen S, Wang XM, Xu F, Xu XZ, Zhu QJ, Wang XD, Liu XH, Liu Y, Hu Y, Wang W, Ai Q, Dang HX, Gao HM, Fan CN, Qian SY. [Respiratory virus infection and its influence on outcome in children with septic shock]. Zhonghua Er Ke Za Zhi 2024; 62:211-217. [PMID: 38378281 DOI: 10.3760/cma.j.cn112140-20231014-00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Objective: To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes. Methods: The clinical data of children with septic shock in children's PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results: A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs (OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions: The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.
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Affiliation(s)
- G Liu
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - C M Zhang
- Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Y Li
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Soochow University, Suzhou 215025, China
| | - J Y Sun
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Y B Cheng
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450018, China
| | - Y P Chen
- Department of Pediatric Intensive Care Unit, Baoding Children's Hospital, Baoding 071051, China
| | - Z H Wang
- Department of Pediatric Intensive Care Unit, Baoding Children's Hospital, Baoding 071051, China
| | - H Ren
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - C F Liu
- Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Y P Jin
- Department of Pediatric Intensive Care Unit, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - S Chen
- Department of Pediatric Intensive Care Unit, Tianjin Children's Hospital, Tianjin 300074, China
| | - X M Wang
- Department of Hematology, Tianjin Children's Hospital, Tianjin 300074, China
| | - F Xu
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - X Z Xu
- Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Q J Zhu
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Soochow University, Suzhou 215025, China
| | - X D Wang
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450018, China
| | - X H Liu
- Department of Pediatric Intensive Care Unit, Baoding Children's Hospital, Baoding 071051, China
| | - Y Liu
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Y Hu
- Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - W Wang
- Department of Pediatric Intensive Care Unit, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Q Ai
- Department of Hematology, Tianjin Children's Hospital, Tianjin 300074, China
| | - H X Dang
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - H M Gao
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - C N Fan
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Fang BL, Xu F, Lu GP, Ren XX, Zhang YC, Jin YP, Wang Y, Liu CF, Cheng YB, Yang QZ, Xiao SF, Yang YY, Huo XM, Lei ZX, Dang HX, Liu S, Wu ZY, Li KC, Qian SY, Zeng JS. [Analysis of risk factors of mortality in infants and toddlers with moderate to severe pediatric acute respiratory distress syndrome]. Zhonghua Er Ke Za Zhi 2023; 61:216-221. [PMID: 36849347 DOI: 10.3760/cma.j.cn112140-20221108-00947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Objective: To identify the risk factors in mortality of pediatric acute respiratory distress syndrome (PARDS) in pediatric intensive care unit (PICU). Methods: Second analysis of the data collected in the "efficacy of pulmonary surfactant (PS) in the treatment of children with moderate to severe PARDS" program. Retrospective case summary of the risk factors of mortality of children with moderate to severe PARDS who admitted in 14 participating tertiary PICU between December 2016 to December 2021. Differences in general condition, underlying diseases, oxygenation index, and mechanical ventilation were compared after the group was divided by survival at PICU discharge. When comparing between groups, the Mann-Whitney U test was used for measurement data, and the chi-square test was used for counting data. Receiver Operating Characteristic (ROC) curves were used to assess the accuracy of oxygen index (OI) in predicting mortality. Multivariate Logistic regression analysis was used to identify the risk factors for mortality. Results: Among 101 children with moderate to severe PARDS, 63 (62.4%) were males, 38 (37.6%) were females, aged (12±8) months. There were 23 cases in the non-survival group and 78 cases in the survival group. The combined rates of underlying diseases (52.2% (12/23) vs. 29.5% (23/78), χ2=4.04, P=0.045) and immune deficiency (30.4% (7/23) vs. 11.5% (9/78), χ2=4.76, P=0.029) in non-survival patients were significantly higher than those in survival patients, while the use of pulmonary surfactant (PS) was significantly lower (8.7% (2/23) vs. 41.0% (32/78), χ2=8.31, P=0.004). No significant differences existed in age, sex, pediatric critical illness score, etiology of PARDS, mechanical ventilation mode and fluid balance within 72 h (all P>0.05). OI on the first day (11.9(8.3, 17.1) vs.15.5(11.7, 23.0)), the second day (10.1(7.6, 16.6) vs.14.8(9.3, 26.2)) and the third day (9.2(6.6, 16.6) vs. 16.7(11.2, 31.4)) after PARDS identified were all higher in non-survival group compared to survival group (Z=-2.70, -2.52, -3.79 respectively, all P<0.05), and the improvement of OI in non-survival group was worse (0.03(-0.32, 0.31) vs. 0.32(-0.02, 0.56), Z=-2.49, P=0.013). ROC curve analysis showed that the OI on the thind day was more appropriate in predicting in-hospital mortality (area under the curve= 0.76, standard error 0.05,95%CI 0.65-0.87,P<0.001). When OI was set at 11.1, the sensitivity was 78.3% (95%CI 58.1%-90.3%), and the specificity was 60.3% (95%CI 49.2%-70.4%). Multivariate Logistic regression analysis showed that after adjusting for age, sex, pediatric critical illness score and fluid load within 72 h, no use of PS (OR=11.26, 95%CI 2.19-57.95, P=0.004), OI value on the third day (OR=7.93, 95%CI 1.51-41.69, P=0.014), and companied with immunodeficiency (OR=4.72, 95%CI 1.17-19.02, P=0.029) were independent risk factors for mortality in children with PARDS. Conclusions: The mortality of patients with moderate to severe PARDS is high, and immunodeficiency, no use of PS and OI on the third day after PARDS identified are the independent risk factors related to mortality. The OI on the third day after PARDS identified could be used to predict mortality.
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Affiliation(s)
- B L Fang
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China
| | - F Xu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing 400014,China
| | - G P Lu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai 201102,China
| | - X X Ren
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020,China
| | - Y C Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200062,China
| | - Y P Jin
- Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021,China
| | - Y Wang
- Department of Pediatric Critical Care Medicine Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127,China
| | - C F Liu
- Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004,China
| | - Y B Cheng
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450000,China
| | - Q Z Yang
- Department of Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng 252000,China
| | - S F Xiao
- Department of Pediatric Intensive Care Unit, Kunming Children's Hospital, Kunming 650034,China
| | - Y Y Yang
- Department of Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou 510623,China
| | - X M Huo
- Department of Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang 050031,China
| | - Z X Lei
- Department of Pediatric Intensive Care Unit, Hainan Women and Children's Medical Center, Haikou 570206, China
| | - H X Dang
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing 400014,China
| | - S Liu
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020,China
| | - Z Y Wu
- Department of Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou 510623,China
| | - K C Li
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China
| | - J S Zeng
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China
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Abstract
Background Reconstruction of clonal evolution is critical for understanding tumor progression and implementing personalized therapies. This is often done by clustering somatic variants based on their cellular prevalence estimated via bulk tumor sequencing of multiple samples. The clusters, consisting of the clonal marker variants, are then ordered based on their estimated cellular prevalence to reconstruct clonal evolution trees, a process referred to as 'clonal ordering'. However, cellular prevalence estimate is confounded by statistical variability and errors in sequencing/data analysis, and therefore inhibits accurate reconstruction of the clonal evolution. This problem is further complicated by intra- and inter-tumor heterogeneity. Furthermore, the field lacks a comprehensive visualization tool to facilitate the interpretation of complex clonal relationships. To address these challenges we developed ClonEvol, a unified software tool for clonal ordering, visualization, and interpretation. Materials and methods ClonEvol uses a bootstrap resampling technique to estimate the cellular fraction of the clones and probabilistically models the clonal ordering constraints to account for statistical variability. The bootstrapping allows identification of the sample founding- and sub-clones, thus enabling interpretation of clonal seeding. ClonEvol automates the generation of multiple widely used visualizations for reconstructing and interpreting clonal evolution. Results ClonEvol outperformed three of the state of the art tools (LICHeE, Canopy and PhyloWGS) for clonal evolution inference, showing more robust error tolerance and producing more accurate trees in a simulation. Building upon multiple recent publications that utilized ClonEvol to study metastasis and drug resistance in solid cancers, here we show that ClonEvol rediscovered relapsed subclones in two published acute myeloid leukemia patients. Furthermore, we demonstrated that through noninvasive monitoring ClonEvol recapitulated the emerging subclones throughout metastatic progression observed in the tumors of a published breast cancer patient. Conclusions ClonEvol has broad applicability for longitudinal monitoring of clonal populations in tumor biopsies, or noninvasively, to guide precision medicine. Availability ClonEvol is written in R and is available at https://github.com/ChrisMaherLab/ClonEvol.
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Affiliation(s)
- H X Dang
- McDonnell Genome Institute.,Department of Internal Medicine
| | - B S White
- McDonnell Genome Institute.,Department of Internal Medicine
| | | | | | - J Luo
- Department of Surgery.,Siteman Cancer Center
| | - R C Fields
- Department of Surgery.,Siteman Cancer Center
| | - C A Maher
- McDonnell Genome Institute.,Department of Internal Medicine.,Siteman Cancer Center.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, USA
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