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Published on: February 20, 2021
Prediction of pediatric sepsis mortality within 1 h of intensive care admission
Luregn J Schlapbach1,2,3, Graeme MacLaren4,5, Marino Festa6
1Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia. l.schlapbach@uq.edu.au.
Insights
Pediatric sepsis requires specialized definitions, as current adult criteria are insufficient. A new pediatric sepsis score effectively predicts mortality risk using early ICU admission data.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Adult definitions for sepsis and septic shock have been recently updated.
- Contemporary data are lacking for pediatric sepsis and septic shock definitions.
- There is a need for specialized approaches to pediatric sepsis severity.
Purpose of the Study:
- To derive and validate a pediatric sepsis score for predicting mortality.
- To assess the effectiveness of current septic shock criteria in children.
- To identify key predictors of mortality in pediatric sepsis.
Main Methods:
- Multicenter cohort study of children (<16 years) admitted to ICUs in Australia and New Zealand (2012-2015).
- Assessed septic shock criteria at ICU admission to define sepsis severity.
- Developed a pediatric sepsis score using multivariable logistic regression with variables available within 60 minutes of ICU admission.
Main Results:
- 1697 children with sepsis/septic shock admitted to the ICU; 8.5% mortality.
- Current septic shock criteria (2005 consensus) showed low specificity for predicting mortality (AUC=0.69).
- A derived pediatric sepsis score (AUC=0.817) effectively predicted 30-day mortality, with higher scores indicating increased risk.
Conclusions:
- Pediatric sepsis exhibits distinct mortality patterns necessitating tailored definitions.
- Lactate levels, cardiovascular status, and respiratory function at ICU admission are crucial for identifying high-risk children.
- The developed pediatric sepsis score aids in risk stratification and timely intervention for critically ill children.
Purpose:
The definitions of sepsis and septic shock have recently been revised in adults, but contemporary data are needed to inform similar approaches in children.
Methods:
Multicenter cohort study including children <16 years admitted with sepsis or septic shock to ICUs in Australia and New Zealand in the period 2012-2015. We assessed septic shock criteria at ICU admission to define sepsis severity, using 30-day mortality as outcome. Through multivariable logistic regression, a pediatric sepsis score was derived using variables available within 60 min of ICU admission.
Results:
Of 42,523 pediatric admissions, 4403 children were admitted with invasive infection, including 1697 diagnosed as having sepsis/septic shock on admission. Mortality was 8.5% (144/1697) and 50.7% of deaths occurred within 48 h of admission. The presence of septic shock as defined by the 2005 consensus was sensitive but not specific in predicting mortality (AUC = 0.69; 95% CI 0.65-0.72). Combinations of hypotension, vasopressor therapy, and lactate >2 mmol/l discriminated poorly (AUC <0.60). Multivariate models showed that oxygenation markers, ventilatory support, hypotension, cardiac arrest, serum lactate, pupil responsiveness, and immunosuppression were the best-performing predictors (0.843; 0.811-0.875). We derived a pediatric sepsis score (0.817; 0.779-0.855), and every one-point increase was associated with a 28.5% (23.8-33.2%) increase in the odds of death. Children with a score ≥6 had 19.8% mortality and accounted for 74.3% of deaths. The sepsis score performed comparably when applied to all children admitted with invasive infection (0.810; 0.781-0.840).
Conclusions:
We observed mortality patterns specific to pediatric sepsis that support the need for specialized definitions of sepsis severity in children. We demonstrated the importance of lactate, cardiovascular, and respiratory derangements at ICU admission for the identification of children with substantially higher risk of sepsis mortality.
