TY - JOUR
T1 - New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis
T2 - A Sepsis Phenotype With Higher Morbidity and Mortality
AU - Sepsis Prevalence, Outcomes, and Therapy Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network
AU - Lin, John C.
AU - Spinella, Philip C.
AU - Fitzgerald, Julie C.
AU - Tucci, Marisa
AU - Bush, Jenny L.
AU - Nadkarni, Vinay M.
AU - Thomas, Neal J.
AU - Weiss, Scott L.
AU - Fontela, P.
AU - Tucci, M.
AU - Dumistrascu, M.
AU - Skippen, P.
AU - Krahn, G.
AU - Bezares, E.
AU - Puig, G.
AU - Puig-Ramos, A.
AU - Garcia, R.
AU - Villar, M.
AU - Bigham, M.
AU - Polanski, T.
AU - Latifi, S.
AU - Giebner, D.
AU - Anthony, H.
AU - Hume, J.
AU - Galster, A.
AU - Linnerud, L.
AU - Sanders, R.
AU - Hefley, G.
AU - Madden, K.
AU - Thompson, A.
AU - Shein, S.
AU - Gertz, S.
AU - Han, Y.
AU - Williams, T.
AU - Hughes-Schalk, A.
AU - Chandler, H.
AU - Orioles, A.
AU - Zielinski, E.
AU - Doucette, A.
AU - Orioles, A.
AU - Zielinski, E.
AU - Doucette, A.
AU - Zebuhr, C.
AU - Wilson, T.
AU - Dimitriades, C.
AU - Ascani, J.
AU - Layburn, S.
AU - Valley, S.
AU - Markowitz, B.
AU - Donado, J.
N1 - Publisher Copyright:
Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.
AB - Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.
KW - children
KW - epidemiology
KW - multiple organ dysfunction syndrome
KW - severe sepsis
UR - http://www.scopus.com/inward/record.url?scp=85008500770&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000000978
DO - 10.1097/PCC.0000000000000978
M3 - Artículo en revista científica indexada
C2 - 28060151
AN - SCOPUS:85008500770
SN - 1529-7535
VL - 18
SP - 8
EP - 16
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 1
ER -