Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis.
Child
Child, Preschool
Cross-Sectional Studies
Female
Hospital Mortality
Humans
Infant
Intensive Care Units, Pediatric
/ statistics & numerical data
Length of Stay
/ statistics & numerical data
Male
Postoperative Complications
/ diagnosis
Prospective Studies
Risk Factors
Sepsis
/ diagnosis
Severity of Illness Index
Surgical Procedures, Operative
/ adverse effects
Medical sepsis
Mortality
Pediatric sepsis
Surgical sepsis
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
07
12
2018
revised:
20
03
2019
accepted:
04
04
2019
pubmed:
11
5
2019
medline:
31
1
2020
entrez:
11
5
2019
Statut:
ppublish
Résumé
Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality. Data were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality. A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death. Pediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population.
Sections du résumé
BACKGROUND
Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality.
METHODS
Data were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality.
RESULTS
A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death.
CONCLUSIONS
Pediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population.
Identifiants
pubmed: 31075654
pii: S0022-4804(19)30198-2
doi: 10.1016/j.jss.2019.04.011
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
100-110Investigateurs
P Fontela
(P)
M Tucci
(M)
M Dumistrascu
(M)
P Skippen
(P)
G Krahn
(G)
E Bezares
(E)
G Puig
(G)
A Puig-Ramos
(A)
R Garcia
(R)
M Villar
(M)
M Bigham
(M)
T Polanski
(T)
S Latifi
(S)
D Giebner
(D)
H Anthony
(H)
J Hume
(J)
A Galster
(A)
L Linnerud
(L)
R Sanders
(R)
G Hefley
(G)
K Madden
(K)
A Thompson
(A)
S Shein
(S)
S Gertz
(S)
Y Han
(Y)
T Williams
(T)
A Hughes-Schalk
(A)
H Chandler
(H)
A Orioles
(A)
E Zielinski
(E)
A Doucette
(A)
A Orioles
(A)
E Zielinski
(E)
A Doucette
(A)
C Zebuhr
(C)
T Wilson
(T)
C Dimitriades
(C)
J Ascani
(J)
S Layburn
(S)
S Valley
(S)
B Markowitz
(B)
J Terry
(J)
R Morzov
(R)
A Mcinnes
(A)
J McArthur
(J)
K Woods
(K)
K Murkowski
(K)
M Spaeder
(M)
M Sharron
(M)
D Wheeler
(D)
E Beckman
(E)
E Frank
(E)
K Howard
(K)
C Carroll
(C)
S Nett
(S)
D Jarvis
(D)
V Patel
(V)
R Higgerson
(R)
L Christie
(L)
K Typpo
(K)
J Deschenes
(J)
A Kirby
(A)
T Uhl
(T)
K Rehder
(K)
I Cheifetz
(I)
S Wrenn
(S)
K Kypuros
(K)
K Ackerman
(K)
F Maffei
(F)
G Bloomquist
(G)
N Rizkalla
(N)
D Kimura
(D)
S Shah
(S)
C Tigges
(C)
F Su
(F)
C Barlow
(C)
K Michelson
(K)
K Wolfe
(K)
D Goodman
(D)
L Campbell
(L)
L Sorce
(L)
K Bysani
(K)
T Monjure
(T)
M Evans
(M)
B Totapally
(B)
M Chegondi
(M)
C Rodriguez
(C)
J Frazier
(J)
L Steele
(L)
S Viteri
(S)
A Costarino
(A)
N Thomas
(N)
D Spear
(D)
E Hirshberg
(E)
J Lilley
(J)
C Rowan
(C)
C Rider
(C)
J Kane
(J)
J Zimmerman
(J)
C Greeley
(C)
J Lin
(J)
R Jacobs
(R)
M Parker
(M)
K Culver
(K)
L Loftis
(L)
N Jaimon
(N)
M Goldsworthy
(M)
J Fitzgerald
(J)
S Weiss
(S)
V Nadkarni
(V)
J Bush
(J)
M Diliberto
(M)
C Allen
(C)
M Gessouroun
(M)
A Sapru
(A)
T Lang
(T)
M Alkhouli
(M)
S Kamath
(S)
D Friel
(D)
J Daufeldt
(J)
D Hsing
(D)
C Carlo
(C)
S Pon
(S)
J Scimeme
(J)
A Shaheen
(A)
A Hassinger
(A)
H Qiao
(H)
J Giuliano
(J)
J Tala
(J)
D Vinciguerra
(D)
A Fernandez
(A)
R Carrero
(R)
P Hoyos
(P)
J Jaramillo
(J)
A Posada
(A)
L Izquiierdo
(L)
B E Piñeres Olave
(BEP)
J Donado
(J)
R Dalmazzo
(R)
S Rendich
(S)
L Palma
(L)
M Lapadula
(M)
C Acuna
(C)
P Cruces
(P)
S Clement De Clety
(SC)
M Dujardin
(M)
C Berghe
(C)
S Renard
(S)
J Zurek
(J)
H Steinherr
(H)
K Mougkou
(K)
E Critselis
(E)
K Mougkou
(K)
M Di Nardo
(M)
S Picardo
(S)
F Tortora
(F)
E Rossetti
(E)
T Fragasso
(T)
P Cogo
(P)
R Netto
(R)
A Dagys
(A)
V Gurskis
(V)
R Kevalas
(R)
C Neeleman
(C)
J Lemson
(J)
C Luijten
(C)
K Wojciech
(K)
I Pagowska-Klimek
(I)
M Szczepanska
(M)
J Karpe
(J)
P Nunes
(P)
H Almeida
(H)
J Rios
(J)
M Vieira
(M)
J P Garcia Iniguez
(JPG)
P Revilla
(P)
J Urbano
(J)
J Lopez-Herce
(J)
A Bustinza
(A)
A Palacios
(A)
S Hofheinz
(S)
A Rodriguez-Nunez
(A)
S Sanagustin
(S)
E Gonzalez
(E)
M Riaza
(M)
R Piaya
(R)
P Soler
(P)
E Esteban
(E)
J Laraudogoitia
(J)
C Monge
(C)
V Herrera
(V)
J Granados
(J)
C Gonzalez
(C)
T Koroglu
(T)
E Ozcelik
(E)
P Baines
(P)
A Plunkett
(A)
P Davis
(P)
S George
(S)
S Tibby
(S)
J Harris
(J)
R Agbeko
(R)
R Lampitt
(R)
J Brierley
(J)
M Peters
(M)
A Jones
(A)
T Dominguez
(T)
T Thiruchelvam
(T)
A Deep
(A)
L Ridley
(L)
W Bowen
(W)
R Levin
(R)
I Macleod
(I)
M Gray
(M)
N Hemat
(N)
J Alexander
(J)
S Ali
(S)
J Pappachan
(J)
J McCorkell
(J)
P Fortune
(P)
M MacDonald
(M)
P Hudnott
(P)
Q Suyun
(Q)
S Singhi
(S)
K Nallasamy
(K)
R Lodha
(R)
N Shime
(N)
Y Tabata
(Y)
O Saito
(O)
T Ikeyama
(T)
T Kawasaki
(T)
L Lum
(L)
A Abidin
(A)
S Kee
(S)
S Tang
(S)
R Jalil
(R)
Y Guan
(Y)
L Yao
(L)
K Lin
(K)
J Ong
(J)
A Salloo
(A)
L Doedens
(L)
L Mathivha
(L)
G Reubenson
(G)
S Moaisi
(S)
A Pentz
(A)
R Green
(R)
A Schibler
(A)
A Fernandez
(A)
S Erickson
(S)
J McEneiry
(J)
D Long
(D)
T Dorofaeff
(T)
M Coulthard
(M)
J Millar
(J)
C Delzoppo
(C)
G Williams
(G)
M Morritt
(M)
N Watts
(N)
M Morritt
(M)
J Beca
(J)
C Sherring
(C)
T Bushell
(T)
Informations de copyright
Copyright © 2019. Published by Elsevier Inc.