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[Prevalence of systemic inflammatory syndromes at a tertiary pediatric intensive care unit]
Paulo R A Carvalho1, Letícia Feldens, Elizabeth E Seitz
1Universidade Federal do Rio Grande do Sul, Porto Alegre, RS. carvalho.conex@uol.com.br
Insights
Systemic inflammatory response syndrome (SIRS) is common in pediatric intensive care units, particularly infectious types. These patients face longer hospital stays and higher mortality risks.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Inflammation research
Context:
- Systemic inflammatory syndromes are frequently encountered in pediatric intensive care units (PICUs).
- Understanding their prevalence and impact is crucial for patient outcomes.
- This study focuses on a tertiary-care university PICU setting.
Purpose:
- To determine the prevalence of systemic inflammatory syndromes upon PICU admission.
- To analyze the relationship between these syndromes and length of hospital stay.
- To assess the association with risk of death and actual mortality rates.
Summary:
- A prospective study of 447 admissions in a pediatric ICU found a 68% prevalence of systemic inflammatory response syndrome (SIRS).
- Infectious SIRS (sepsis, severe sepsis, septic shock) constituted two-thirds of cases.
- Infectious SIRS was linked to significantly higher mortality risk, longer ICU stays, and increased observed mortality compared to non-infectious SIRS.
Impact:
- High prevalence of SIRS, especially infectious types, impacts PICU resource utilization.
- Findings highlight the critical nature of early identification and management of infectious SIRS in critically ill children.
- This research informs clinical practice and resource allocation in pediatric critical care.
Objective:
To assess the prevalence of systemic inflammatory syndromes on admission to a tertiary-care university pediatric intensive care unit (ICU), and relate this to length of hospital stay, risk of death and mortality rate.
Methods:
Cross-sectional, prospective, observational study, including all patients admitted to the Hospital de Clinicas de Porto Alegre (HCPA) ICU between August 1st 1999 and July 31st 2000. Patient demographic variables were considered together with the risk of mortality on admission, co-morbidities, length of hospital stay and ICU outcome, in addition to variables that characterize the systemic inflammatory syndromes (systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock).
Results:
We studied 447 admissions of 388 patients; 54% were male, with a median age of 20 months. The prevalence of systemic inflammatory response syndrome (SIRS) was 68%: 2/3 infectious (sepsis, severe sepsis or septic shock) and 1/3 non-infectious. Risk of mortality scores for patients with infectious SIRS were higher than for those with non-infectious SIRS (6.75% [P25 = 2.25 - P75 = 21.3] vs. 2.35% [P25 = 1.1 - P75 = 6.7]; p = 0) and increased according to SIRS severity (2.9; 10.85, 43.9%; p < 0.05). The observed mortality was 12% for patients with SIRS and 5.8% for those without SIRS (p = 0.057); the observed mortality for infectious SIRS was 14.9% and for non-infectious 6.3% (p = 0.041). The period spent in ICU for infectious SIRS was longer than for non-infectious cases: 3 days (P25 = 2 - P75 = 7) vs. 2 days (P25 = 1.5 - P75 = 4); p = 0.006.
Conclusions:
The prevalence rate of patients with systemic inflammatory response syndrome upon admission to HCPA pediatric intensive care unit was elevated, with a predominance of infectious syndromes, responsible for longer stays, increased risk of mortality and increased mortality of patients during the period evaluated.
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