Cumulative influence of organ dysfunctions and septic state on mortality of critically ill children
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Francis Leclerc1, Stéphane Leteurtre, Alain Duhamel
1Service de Réanimation Pédiatrique, Hôpital Jeanne de Flandre, 59037 Lille, France. fleclerc@chru-lille.fr
Insights
In critically ill children, increasing severity of organ dysfunction and septic state significantly raises mortality risk. The pediatric logistic organ dysfunction (PELOD) score and sepsis category cumulatively impact survival.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Pediatric intensive care
Background:
- The relationship between sepsis and multiple organ dysfunction syndrome (MODS) in children is not well understood.
- Pediatric sepsis is a significant cause of mortality in intensive care settings.
Purpose of the Study:
- To analyze the cumulative impact of organ dysfunction and septic state severity on mortality in critically ill children.
- To quantify the association between the Pediatric Logistic Organ Dysfunction (PELOD) score, sepsis categories, and death risk.
Main Methods:
- Cox regression models were used to analyze data from 593 critically ill children across three pediatric intensive care units.
- The study assessed the influence of the PELOD score and defined septic states (Systemic Inflammatory Response Syndrome/sepsis, severe sepsis, septic shock) on mortality.
- Cumulative hazard ratios were calculated based on the severity of organ dysfunction and the diagnostic category of sepsis.
Main Results:
- Mortality rate was 8.6% among the 593 included children.
- A significant increase in the hazard ratio of death was observed with greater organ dysfunction severity (PELOD score) and worse septic state categories.
- Each one-unit increase in PELOD score increased the hazard ratio by 1.096 (p < 0.0001). Hazard ratios for septic states ranged from 9.039 for SIRS/sepsis to 32.572 for septic shock (p < 0.001).
Conclusions:
- There is a cumulative increase in the risk of death associated with both increasing organ dysfunction severity and worsening septic state categories in critically ill children.
- The PELOD score and sepsis classification are crucial indicators for predicting mortality in pediatric intensive care.
Abstract:
The interaction between sepsis and multiple organ dysfunction syndrome is poorly defined in children. We analyzed by Cox regression models the cumulative influence of organ dysfunctions, using the pediatric logistic organ dysfunction (PELOD) score, and septic state (systemic inflammatory response syndrome or sepsis, severe sepsis, and septic shock) on mortality of critically ill children. We included 593 children (mortality rate: 8.6%) from three pediatric intensive care units; 514 patients had at least a systemic inflammatory response syndrome and 269 had two or more organ dysfunctions. Hazard ratio of death significantly increased with the severity of organ dysfunction, as estimated by the PELOD score, and the worst diagnostic category of septic state. Each increase of one unit in the PELOD score multiplied the hazard ratio by 1.096 (p < 0.0001); hazard ratio of diagnostic category was 9.039 (p = 0.031) for systemic inflammatory response syndrome or sepsis, 18.797 (p = 0.007) for severe sepsis and 32.572 (p < 0.001) for septic shock. Cumulative hazard ratio of death = (hazard ratio of PELOD score) x (hazard ratio of diagnostic category). We conclude that there is a cumulative accrual of the risk of death both with an increasing severity of organ dysfunction and an increasing severity of the diagnostic category of septic state.
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