PDF(Pubmed)
Abstract：
The high-dose usage of norepinephrine is thought to cause high mortality in patients with septic shock. This study aims to explores the correlation between the maximum norepinephrine (NE) dosage (MND) and mortality in neonates with septic shock. This retrospective cohort study included neonates with evidence of septic shock and those who received NE infusion. The study included 123 neonates, with 106 in the survival group and 17 in the death group. The death group exhibited significantly lower birth weight (p = 0.022), 1-min Apgar score (p = 0.005), serum albumin (p < 0.001), and base excess (BE) (p = 0.001) levels, but higher lactate (LAC) levels (p = 0.009) compared to the survival group. MND demonstrated an ROC area under the curve of 0.775 (95% CI 0.63-0.92, p < 0.001) for predicting mortality, with an optimal threshold of 0.3 µg/(kg·min), a sensitivity of 82.4%, and a specificity of 75.5%. Multivariate logistic regression indicated that an MND > 0.3 µg/(kg·min) (OR, 12.08, 95% CI 2.28-64.01) was associated with a significantly higher mortality risk. Spearman rank correlation showed a positive correlation between MND and LAC (r = 0.252, p = 0.005), vasoactive-inotropic score (VIS) (r = 0.836, p < 0.001), and a negative correlation with BE (r = - 0.311, p = 0.001). MND > 0.3 µg/(kg min) is a useful predictive marker of mortality in neonatal septic shock.
摘要：
高剂量使用去甲肾上腺素被认为会导致感染性休克患者的高死亡率。本研究旨在探讨感染性休克新生儿去甲肾上腺素（NE）最大剂量（MND）与死亡率之间的相关性。这项回顾性队列研究包括有感染性休克证据的新生儿和接受NE输注的新生儿。这项研究包括123名新生儿，存活组106人，死亡组17人。死亡组出生体重显著降低(p=0.022),1分钟阿普加评分（p=0.005），血清白蛋白（p<0.001），和碱过量(BE)(p=0.001)水平，但乳酸（LAC）水平高于生存组（p=0.009）。MND显示用于预测死亡率的曲线下ROC面积为0.775（95％CI0.63-0.92，p<0.001），最佳阈值为0.3µg/(kg·min)，灵敏度为82.4%，特异性为75.5%。多变量逻辑回归表明MND>0.3µg/(kg·min)(OR，12.08，95%CI2.28-64.01）与显著较高的死亡风险相关。Spearman等级相关显示MND和LAC之间呈正相关（r=0.252，p=0.005）。血管活性肌力评分（VIS）（r=0.836，p<0.001），与BE呈负相关(r=-0.311，p=0.001)。MND>0.3µg/（kgmin）是新生儿败血性休克死亡率的有用预测指标。
