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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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Boeddha, Navin P., Schlapbach, Luregn J., Driessen, Gertjan J., Herberg, Jethro A., Rivero-Calle, Irene, Cebey-López, Miriam, Klobassa, Daniela S., Philipsen, Ria, de Groot, Ronald, Inwald, David P. et al.
(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

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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
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:
DateEvent
31 May 2018Published
29 April 2018Accepted
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:
Project/Grant IDRIOXX Funder NameFunder ID
279185Seventh Framework Programmehttp://dx.doi.org/10.13039/100011102
342730_153158/1[SNSF] Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschunghttp://dx.doi.org/10.13039/501100001711
UNSPECIFIEDSwiss Society of Intensive CareUNSPECIFIED
UNSPECIFIEDGottfried und Julia Bangerter-Rhyner-Stiftunghttp://dx.doi.org/10.13039/501100005688
UNSPECIFIEDVinetum and Borer FoundationUNSPECIFIED
UNSPECIFIEDFoundation for the Health of Children and AdolescentsUNSPECIFIED
UNSPECIFIED[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
UNSPECIFIEDNewcastle upon Tyne Hospitals NHS Foundation Trusthttp://dx.doi.org/10.13039/501100003776
UNSPECIFIEDNewcastle Universityhttp://dx.doi.org/10.13039/501100000774

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