Log in | Register

Incidence and risk factors for mortality in paediatric severe sepsis: results from the national paediatric intensive care registry in Japan

Nobuaki Shime| Tatsuya Kawasaki| Osamu Saito| Yoko Akamine| Yuichiro Toda| Muneyuki Takeuchi| Hiroko Sugimura| Yoshio Sakurai| Masatoshi Iijima| Ikuya Ueta| Naoki Shimizu| Satoshi Nakagawa
Pediatric Original
Volume 38, Issue 7 / July , 2012

Pages 1191 - 1197

Abstract

Purpose

To assess the incidence, background, outcome and risk factors for death of severe sepsis in Japanese paediatric intensive care units (PICUs).

Methods

A data analysis of a prospective, multicentre, 3-year case registry from nine medical-surgical Japanese PICUs. Children with severe sepsis, aged 0–15 years, who were consecutively admitted to the participating PICUs from 1 January 2007 to 31 December 2009 were enrolled. The incidence, background, causative pathogens or infective foci, outcome and risk factors for death caused by severe sepsis were analysed.

Results

One hundred forty-one cases were registered. After the exclusion of 14 patients because of incomplete data or inappropriate entry, 127 patients were eligible for the analysis. There were 60 boys and 67 girls, aged 23 [5–68] (median [IQR]) months and weighed 10 [5.5–16.5] kg. The incidence was 1.4 % of total PICU admissions. Sepsis was community-acquired in 35 %, PICU-acquired in 37 % and acquired in hospital general wards in 28 %. Methicillin-resistant Staphylococcus aureus was the most frequent pathogen. The crude 28-day mortality was 18.9 %, comparable to the mean PIM-2 predicted mortality (17.7 %). The mortality rate in patients with shock was significantly increased to 28 % compared to those without shock (5 %). The presences of existing haematological disorders (OR 8.97, 95 % CI, 1.56–51.60) and shock (OR 5.35, 1.04–27.44) were significant factors associated with mortality by multivariate analysis.

Conclusions

The mortality from severe sepsis/septic shock in Japanese PICUs was ~19 %. Haematological disorders and presence of shock were associated with death.

Keywords

References

  1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310
    • View reference on PubMed
    • View reference on publisher's website
  2. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554
    • View reference on PubMed
    • View reference on publisher's website
  3. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL (2007) Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med 35:1444–1450
    • View reference on publisher's website
  4. Watson SR, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC (2003) The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 167:695–701
    • View reference on PubMed
    • View reference on publisher's website
  5. Goldstein B, Giroir B, Randolph A, Members of the International Consensus Conference Panel (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8
    • View reference on PubMed
    • View reference on publisher's website
  6. Calanda T (2005) The International Sepsis Forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 33:1538–1548
    • View reference on publisher's website
  7. Slater A, Shann F, Pearson G, For the PIM Study Group (2003) PIM2: a revised version of the paediatric index of mortality. Intensive Care Med 29:278–285
    • View reference on PubMed
  8. Wolfler A, Silvani P, Musicco M, Antonelli M, Salvo I, The Italian Paediatric Sepsis Study (SISPe) group (2007) Incidence of and mortality due to sepsis, severe sepsis and septic shock in Italian Paediatric Intensive Care Units: a prospective national survey. Intensive Care Med 34:1690–1697
  9. Inwald DP, Tasker RC, Peters MJ, Nadel S, Paediatric Intensive Care Society Study Group (PICS-SG) (2009) Emergency management of children with severe sepsis in the United Kingdom: the results of the Paediatric Intensive Care Society sepsis audit. Arch Dis Child 94:348–353
    • View reference on PubMed
    • View reference on publisher's website
  10. Proulx F, Fayon M, Farrell CA, Lacroix J, Gauthier M (1996) Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 109:1033–1038
    • View reference on PubMed
    • View reference on publisher's website
  11. Leclerc F, Leteurtre S, Duhamel A, Grandbastien B, Proulx F, Martinot A, Gauvin F, Hubert P, Lacroix J (2005) Cumulative influence of organ dysfunctions and septic state on mortality of critically ill children. Am J Respir Crit Care Med 171:348–353
    • View reference on PubMed
    • View reference on publisher's website
  12. Kutko MC, Calarco MP, Flaherty MB, Helmrich RF, Ushay HM, Pon S, Greenwald BM (2003) Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med 4:333–337
    • View reference on PubMed
    • View reference on publisher's website
  13. Goh A, Lum L (1999) Sepsis, severe sepsis and septic shock in paediatric multiple organ dysfunction syndrome. J Paediatr Child Health 35:488–492
    • View reference on PubMed
    • View reference on publisher's website
  14. Maat M, Buysse CMP, Emonts M, Spanjaard L, Joosten KFM, de Groot R, Hazelzet JA (2007) Improved survival of children with sepsis and purpura: effects of age, gender, and era. Crit Care 11:R112
    • View reference on PubMed
    • View reference on publisher's website
  15. Haddy RI, Perry K, Chacko CE, Helton WB, Bowling MG, Looney SW, Buck GE (2005) Comparison of incidence of invasive Streptococcus pneumonia disease among children before and after introduction of conjugated pneumococcal vaccine. Pediatr Infect Dis J 24:320–323
    • View reference on PubMed
    • View reference on publisher's website
  16. Jacobs RF, Sowell MK, Moss MM, Fiser DH (1990) Septic shock in children: bacterial aetiologies and temporal relationship. Pediatr Infect Dis J 9:196–200
    • View reference on PubMed
    • View reference on publisher's website
  17. Fiser RT, West NK, Bush AJ, Sillos EM, Schmidt JE, Tamburro RF (2005) Outcome of severe sepsis in pediatric oncology patients. Pediatr Crit Care Med 6:531–536
    • View reference on PubMed
    • View reference on publisher's website
  18. Pound CM, Johnston DL, Armstrong R, Gaboury I, Menon K (2008) The morbidity and mortality of pediatric oncology patients presenting to the intensive care unit with septic shock. Pediatr Blood Cancer 51:584–588
    • View reference on PubMed
    • View reference on publisher's website
  19. Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, Orr RA (2003) Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 112:793–799
    • View reference on PubMed
    • View reference on publisher's website
  20. Oliveira CF, Nogueira Sa´FR, Oliveira DS, Gottschald AF, Moura JD, Shibata AR, Troster EJ, Vaz FA, Carcillo JA (2008) Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of critical care medicine/pediatric advanced life support guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care 24:810–815
  21. Brierley J, Choong K, Cornell T, Decaen A, Deymann A, Doctor A, Davis A, Duff J, Dugas MA, Duncan A, Evans B, Feldman J, Felmet K, Fisher G, Frankel L, Jeffries H, Greenwald B, Gutierrez J, Han K, Hanson J, Hazelzet J, Hernan L, Kiff J, Kissoon N, Kon A, Irazusta J, Lin J, Lorts A, Mariscalco M, Mehta R, Nadel S, Nguyen T, Nicholson C, Peters M, Okhuysen-Cawley R, Poulton T, Relves M, Rodriguez A, Rozenfeld R, Schnitzler E, Shanley T, Skache S, Skippen P, Torres A, von Dessauer CB, Weingarten J, Zaritsky A, Stojadinovic B, Zimmerman J, Zuckerberg A (2009) 2007 American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med 37:666–688
    • View reference on PubMed
    • View reference on publisher's website
  22. Ceneviva G, Paschall JA, Maffei F, Carcillo JA (1998) Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 102:e19
    • View reference on PubMed
    • View reference on publisher's website
  23. Randolph A (2005) The purpose of the 1st International sepsis forum on sepsis in infants and children. Pediatr Crit Care Med 6:S1–S2
  24. Launay E, Gras-Le Guen C, Martinot A, Assathiany R, Blanchais T, Mourdi N, Aouba A, Bouvier-Colle MH, Rozé JC, Chalumeau M (2010) Suboptimal care in the initial management of children who died from severe bacterial infection: a population-based confidential inquiry. Pediatr Crit Care Med 11:469–474
  25. Sligl WI, Milner DA Jr, Sundar S, Mphatswe W, Majumdar SR (2009) Safety and efficacy of corticosteroids for the treatment of septic shock: a systematic review and meta-analysis. Clin Infect Dis 49:93–101
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement