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.
目的： 了解儿童重症监护病房（PICU）内脓毒性休克患儿常见呼吸道病毒的感染情况及其对临床结局及预后的影响。 方法： 收集2018年1月至2021年12月中国10家医院PICU中脓毒性休克患儿的临床和诊疗相关数据进行回顾性分析。按休克发生在新型冠状病毒感染疫情前后分为疫情前和疫情后两组，对比分析两组患儿临床特征以及呼吸道病毒构成变化；以年龄、恶性肿瘤基础病、细菌、真菌、其他病毒为匹配因素，利用1∶1倾向性评分匹配方法分为呼吸道病毒组和无呼吸道病毒组，比较两组患儿临床特征及诊治差异。组间比较采用两独立样本t检验、Mann-Whitney U 检验和χ2检验，利用Logistic回归分析呼吸道病毒感染和部分临床结局的相关性。 结果： 共纳入脓毒性休克患儿1 247例，年龄37（11，105）月龄，其中男748例。疫情前组530例，疫情后组717例，呼吸道病毒阳性率分别为14.9%（79例）和9.8%（70例）。疫情前、后两组脓毒性休克季节分布比例秋、冬季分别为28.9%（153/530）、30.3%（161/530）和25.9%（185/717）、28.3%（203/717），对应的呼吸道病毒阳性率分别为19.6%（30/153）、21.1%（34/161）和15.7%（29/185）、15.3%（31/203）。疫情后组流感病毒和腺病毒阳性率均低于疫情前组［2.1%（15/717）比7.5%（40/530）、0.7%（5/717）比3.2%（17/530），χ2=21.51、11.08，均P<0.05］，但鼻病毒高于疫情前组［1.7%（12/717）比0.2%（1/530），χ2=6.51，P=0.011］。倾向性评分匹配后呼吸道病毒组和无呼吸道病毒组各147例。前者呼吸衰竭和急性呼吸窘迫、弥散性血管内凝血功能障碍和免疫球蛋白使用占比均高于后者［77.6%（114/147）比59.2%（87/147）、17.7%（26/147）比4.1%（6/147）、15.6%（25/147）比4.1%（7/147）、35.4%（52/147）比21.4%（32/147），χ2=11.07、14.02、11.06、6.67，均P<0.05］，前者PICU住院时间长于后者［7（3，16）比3（1，7）d，Z=5.01，P<0.001］。单因素Logistic回归分析提示存在呼吸道病毒感染与发生呼吸衰竭和弥散性凝血功能障碍、有创机械通气时间、使用免疫球蛋白和抗呼吸道病毒药物均有一定相关性（OR=2.42、0.22、0.25、0.56、1.12，均P<0.05）。 结论： 疫情前后脓毒性休克患儿呼吸道病毒构成存在差异。呼吸道病毒感染与脓毒性休克患儿发生部分器官功能障碍有关。通过呼吸道保护减少呼吸道病毒感染，或许有利于改善儿童群体相关脓毒性休克的临床结局。.