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Day 1 multiple organ dysfunction syndrome is associated with poor functional outcome and mortality in the pediatric
Katri V Typpo1, Nancy J Petersen, D Michael Hallman
1Baylor College of Medicine, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
Insights
Pediatric patients with multiple organ dysfunction syndrome (MODS) on day 1 of intensive care have worse outcomes and higher mortality. Infants are disproportionately affected by early MODS, highlighting a critical area for intervention.
Area of Science:
- Pediatric critical care medicine
- Epidemiology of critical illness
- Organ dysfunction syndromes
Background:
- Multiple organ dysfunction syndrome (MODS) in children is not well understood due to limited data and inconsistent diagnostic criteria.
- Characterizing early MODS is crucial for understanding its impact on pediatric intensive care unit (PICU) patients.
Purpose of the Study:
- To describe the epidemiology and outcomes of early MODS in a large cohort of pediatric intensive care unit patients.
- To utilize consensus definitions for organ failure to improve characterization of MODS in children.
Main Methods:
- Retrospective analysis of a large, contemporaneously collected clinical database (Virtual Pediatric Intensive Care Unit Performance System).
- Inclusion of over 44,000 PICU admissions from 28 U.S. children's hospitals between January 2004 and December 2005.
- Identification of day 1 MODS using International Pediatric Sepsis Consensus Conference criteria and assessment of functional status via Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores.
Main Results:
- Day 1 MODS was identified in 18.6% of pediatric intensive care unit admissions.
- Patients with day 1 MODS exhibited significantly higher mortality (10.0% vs. 1.2%), longer PICU stays, and poorer functional outcomes at discharge.
- Infants demonstrated the highest incidence of day 1 MODS (25.2%) compared to other age groups.
Conclusions:
- Early-onset MODS in pediatric intensive care patients is associated with substantially worse outcomes, including increased mortality and prolonged hospitalization.
- Infants represent a particularly vulnerable population, experiencing a disproportionately high rate of early MODS.
- This study provides critical epidemiological data on early MODS in children, underscoring the need for targeted interventions and further research.
Objective:
The epidemiology and outcomes of multiple organ dysfunction syndrome (MODS) are incompletely characterized in the pediatric population due to small sample size and conflicting diagnoses of organ failure. We sought to describe the epidemiology and outcomes of early MODS in a large clinical database of pediatric intensive care unit (PICU) patients based on consensus definitions of organ failure.
Design:
Retrospective analysis of a contemporaneously collected clinical PICU database.
Setting:
Virtual Pediatric Intensive Care Unit Performance System database patient admissions from January 2004 to December 2005 for 35 U.S. children's hospitals.
Patients:
: We evaluated 63,285 consecutive PICU admissions from January 2004 to December 2005 in the Virtual Pediatric Intensive Care Unit Performance System database. We excluded patients younger than 1 month or older than 18 years of age, and hospitals with >10% missing values for MODS variables. We identified day 1 MODS by International Pediatric Sepsis Consensus Conference criteria with day 1 laboratory and vital sign values. We evaluated functional status using Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores from PICU admission and discharge.
Analysis:
Student's t test, chi-square test, Mann-Whitney rank sum, Kruskal-Wallis, and linear and logistic regression.
Measurements And Main Results:
We analyzed 44,693 admissions from 28 hospitals meeting inclusion criteria. Overall PICU mortality was 2.8%. We identified day 1 MODS in 18.6% of admissions. Patients with day 1 MODS had higher mortality (10.0% vs. 1.2%, p < .001), longer PICU length of stay (3.6 vs. 1.3 days, p < .001), and larger change from baseline Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores at time of PICU discharge (p < .001). Infants had the highest incidence of day 1 MODS (25.2% vs. 16.5%, p < .001) compared with other age groups.
Conclusions:
Using the largest clinical dataset to date and consensus definitions for organ failure, we found that children with MODS present on day 1 of intensive care unit admission have worse functional outcomes, higher mortality, and longer PICU length of stay than children who do not have MODS on day 1. Infants are disproportionally affected by MODS.
