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New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher
John C Lin1, Philip C Spinella, Julie C Fitzgerald
11Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.2Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.3Division of Critical Care Medicine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada.4Pediatric Critical Care Medicine, Departments of Pediatrics and Public Health Sciences, Penn State University College of Medicine, Hershey, PA.
Insights
New or progressive multiple organ dysfunction syndrome (MODS) is common in pediatric severe sepsis, affecting 26% of patients. This condition significantly increases the risk of death and long-term disability in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Severe sepsis in children is a critical condition with significant morbidity and mortality.
- Multiple organ dysfunction syndrome (MODS) is a common and severe complication of pediatric sepsis.
- Understanding the incidence and impact of new or progressive MODS is crucial for improving outcomes.
Purpose of the Study:
- To describe the epidemiology, morbidity, and mortality associated with new or progressive multiple organ dysfunction syndrome (MODS) in pediatric patients with severe sepsis.
- To evaluate the association between new or progressive MODS and hospital mortality and long-term disability.
Main Methods:
- Secondary analysis of a prospective, cross-sectional, point prevalence study.
- Involved 567 pediatric patients with severe sepsis from 128 pediatric intensive care units (PICUs) across 26 countries.
- Data collected on the development of new or progressive MODS within 7 days of sepsis recognition.
Main Results:
- 26% of pediatric severe sepsis patients developed new or progressive MODS.
- Hospital mortality was significantly higher in patients with progressive MODS (51%) and new MODS (28%) compared to those without (10%).
- Survivors of new or progressive MODS experienced higher rates of moderate to severe disability (29% and 22%, respectively).
Conclusions:
- New or progressive MODS is a frequent complication of pediatric severe sepsis, significantly increasing mortality and morbidity.
- The findings support the use of new or progressive MODS as a key outcome in clinical trials for pediatric severe sepsis.
- Further research is needed to confirm if reducing new or progressive MODS translates to improved definitive morbidity and mortality endpoints.
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.
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