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Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units : a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS).
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(2018) Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units : a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Critical Care, 22 . (143). doi:10.1186/s13054-018-2052-7
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Official URL: http://dx.doi.org/10.1186/s13054-018-2052-7
Abstract
Background
Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability.
Methods
Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis.
Results
Patients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1–16.0, P = 0.04; disability OR 5.4, 95% CI 1.8–15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3–6.1, P < 0.01; disability OR 3.4, 95% CI 1.8–6.4, P < 0.001).
Conclusions
Despite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.
| Item Type: | Journal Article | ||||||||||||||||||||||||||||||
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| Subjects: | R Medicine > RJ Pediatrics | ||||||||||||||||||||||||||||||
| Divisions: | Faculty of Science > Life Sciences (2010- ) | ||||||||||||||||||||||||||||||
| SWORD Depositor: | Library Publications Router | ||||||||||||||||||||||||||||||
| Library of Congress Subject Headings (LCSH): | Septicemia in children, Bacteremia, Meningococcal infections | ||||||||||||||||||||||||||||||
| Journal or Publication Title: | Critical Care | ||||||||||||||||||||||||||||||
| Publisher: | BioMed Central Ltd. | ||||||||||||||||||||||||||||||
| ISSN: | 1466-609X | ||||||||||||||||||||||||||||||
| Official Date: | 31 May 2018 | ||||||||||||||||||||||||||||||
| Dates: |
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| Volume: | 22 | ||||||||||||||||||||||||||||||
| Article Number: | (143) | ||||||||||||||||||||||||||||||
| DOI: | 10.1186/s13054-018-2052-7 | ||||||||||||||||||||||||||||||
| Status: | Peer Reviewed | ||||||||||||||||||||||||||||||
| Publication Status: | Published | ||||||||||||||||||||||||||||||
| Access rights to Published version: | Open Access | ||||||||||||||||||||||||||||||
| RIOXX Funder/Project Grant: |
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