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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.0179

摘要内容如下：

重要性

败血症是全世界儿童死亡的主要原因。根据专家意见，2005年发布了当前儿科脓毒症的特定标准。2016年，脓毒症和脓毒性休克的第三次国际共识定义（SEPSIS-3）将脓毒症定义为宿主对感染的反应失调导致的危及生命的器官功能障碍，但不包括儿童。

目的

更新和评估儿童脓毒症和脓毒性休克的标准。

证据审查

重症医学学会（SCCM）召集了一个由来自六大洲的重症护理、急诊医学、传染病、普通儿科、护理、公共卫生和新生儿科的35名儿科专家组成的工作组。使用来自国际调查、系统综述和荟萃分析的证据，以及基于来自四大洲10个地点的300多万次电子健康档案接触而开发的新的器官功能障碍评分，采用改良的德尔菲共识过程来开发标准。

调查结果

根据调查数据，大多数儿科临床医生使用脓毒症来指代具有危及生命的器官功能障碍的感染，这与先前使用全身炎症反应综合征（SIRS）标准的儿科脓毒症标准不同，后者具有较差的预测性，并包括多余的术语“严重脓毒症”。SCCM工作组建议，在疑似感染的儿童中，通过至少2分的Phoenix脓毒症评分来识别儿童脓毒症，这表明呼吸、心血管、凝血和/或神经系统的潜在危及生命的功能障碍。Phoenix脓毒症评分至少为2分的儿童在高资源环境中的住院死亡率为7.1%，在低资源环境中的住院死亡率为28.5%，是不符合这些标准的疑似感染儿童的8倍多。呼吸、心血管、凝血和/或神经器官系统中至少有1个器官功能障碍的儿童死亡率较高，而这些器官功能障碍不是感染的主要部位。脓毒性休克是指患有脓毒症的儿童出现心血管功能障碍，在Phoenix脓毒症评分中至少有1个心血管点，包括严重低血压、血乳酸超过5 mmol/L或需要血管活性药物治疗。在资源较高和资源较低的环境中，感染性休克患儿的住院死亡率分别为10.8%和33.5%。

结论和相关性

国际儿科脓毒症定义工作组（SCCM Pediatric Sepsis Definition Task Force）使用大型国际数据库和调查、系统综述和荟萃分析以及改良的德尔菲共识（Delphi Consensus）方法，得出并验证了儿童脓毒症和脓毒性休克的Phoenix脓毒症标准。Phoenix脓毒症评分至少为2分，可确定18岁以下感染儿童的潜在危及生命的器官功能障碍，其应用有可能改善世界各地儿科脓毒症和脓毒性休克的临床护理、流行病学评估和研究。

英文原文如下：

Abstracts

Importance  Sepsis is a leading cause of death among children worldwide. Current pediatric-specific criteria for sepsis were published in 2005 based on expert opinion. In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, but it excluded children.

Objective  To update and evaluate criteria for sepsis and septic shock in children.

Evidence Review  The Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria.

Findings  Based on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria. Mortality was higher in children who had organ dysfunction in at least 1 of 4-respiratory, cardiovascular, coagulation, and/or neurological-organ systems that was not the primary site of infection. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively.

Conclusions and Relevance  The Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world.

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