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Epidemiology of Sepsis in Children Admitted to PICUs in South America
Daniela Carla de Souza1, Huei Hsin Shieh, Eliane Roseli Barreira
111Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitário da Universidade de São Paulo, Sao Paulo, SP, Brazil. 2Department of Pediatrics, Medical School, Universidade de São Paulo, Sao Paulo, SP, Brazil. 3Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Insights
Sepsis is common in South American pediatric intensive care units (PICUs), affecting over 40% of critically ill children. High mortality rates, especially with severe sepsis or septic shock, highlight the need for timely intervention.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- The prevalence and outcomes of pediatric sepsis in South America are not well-characterized.
Purpose of the Study:
- To determine the prevalence of sepsis within 24 hours of admission.
- To report sepsis-related mortality in critically ill children admitted to Pediatric Intensive Care Units (PICUs) in South America.
Main Methods:
- A prospective, multicenter cohort study was conducted across 21 PICUs in five South American countries.
- Data on clinical, demographic, and laboratory findings were collected within 24 hours of admission for 1,090 children aged 29 days to 17 years.
- Outcomes were recorded upon PICU discharge or death.
Main Results:
- Sepsis was prevalent in 42.6% of critically ill children, with severe sepsis and septic shock occurring in 25.9% and 19.8%, respectively.
- Sepsis-related mortality was 14.2%, increasing with disease severity (4.4% for sepsis, 12.3% for severe sepsis, 23.1% for septic shock).
- Factors associated with mortality included higher severity scores (PRISM, P-Log), multiple comorbidities, and delayed PICU referral.
Conclusions:
- High prevalence of sepsis and significant sepsis-related mortality were observed in South American PICUs.
- Mortality is linked to illness severity at admission and potentially delayed referral to the PICU.
- Findings underscore the critical need for early recognition and management of pediatric sepsis in the region.
Objectives:
To report the prevalence of sepsis within the first 24 hours at admission and the PICU sepsis-related mortality among critically ill children admitted to PICU in South America.
Design:
A prospective multicenter cohort study.
Setting:
Twenty-one PICU, located in five South America countries.
Patients:
All children from 29 days to 17 years old admitted to the participating PICU between June 2011 and September 2011. Clinical, demographic, and laboratory data were registered within the first 24 hours at admission. Outcomes were registered upon PICU discharge or death.
Interventions:
None.
Measurements And Main Results:
Of the 1,090 patients included in this study, 464 had sepsis. The prevalence of sepsis, severe sepsis, and septic shock were 42.6%, 25.9%, and 19.8%, respectively. The median age of sepsis patients was 11.6 months (interquartile range, 3.2-48.7) and 43% had one or more prior chronic condition. The prevalence of sepsis was higher in infants (50.4%) and lower in adolescents (1.9%). Sepsis-related mortality was 14.2% and was consistently higher with increased disease severity: 4.4% for sepsis, 12.3% for severe sepsis, and 23.1% for septic shock. Twenty-five percent of deaths occurred within the first 24 hours at PICU admission. Multivariate analysis showed that higher Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, the presence of two or more chronic conditions, and admission from pediatric wards were independently associated with death.
Conclusions:
We observed high prevalence of sepsis and sepsis-related mortality among this sample of children admitted to PICU in South America. Mortality was associated with greater severity of illness at admission and potentially associated with late PICU referral.
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