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Use of plasma exchange in pediatric severe sepsis in children's hospitals
Lisa M Lima1, Courtney E McCracken1, James D Fortenberry2
1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.
Insights
Pediatric severe sepsis (PSS) mortality decreased over time, but plasma exchange (PE) use remained stable. Children receiving PE had higher mortality, likely due to greater illness severity and comorbidities.
Area of Science:
- Pediatric critical care medicine
- Intensive care unit (ICU) management
- Extracorporeal therapies
Background:
- Pediatric severe sepsis (PSS) is a leading cause of childhood mortality.
- Multiple organ dysfunction syndrome (MODS) significantly increases PSS mortality.
- Plasma exchange (PE) is an adjunctive therapy for sepsis with variable reported efficacy.
Purpose of the Study:
- To analyze demographics, PE utilization, mortality, and resource use in children with PSS.
- To compare outcomes between PSS patients who did and did not receive PE.
- To identify trends in PE use and PSS outcomes from 2004 to 2012.
Main Methods:
- Observational retrospective cohort study.
- Analysis of data from 49,153 PSS cases across 43 children's hospitals (2004-2012).
- Comparison of characteristics and outcomes for PSS patients with and without PE, stratified by MODS presence.
Main Results:
- PE was used in 1.8% of PSS cases, increasing to 4.8% in those with MODS.
- PE patients had longer hospitalizations (39 vs. 17 days) and higher overall mortality (32.1% vs. 14.1%).
- Mortality in PE patients was 22% without MODS and 44.4% with MODS; mortality decreased over time in both PE subgroups.
Conclusions:
- PE utilization in PSS remained stable, while PSS mortality declined during the study period.
- Children receiving PE had higher mortality, greater comorbidities, and higher MODS prevalence, indicating use in sicker patients.
- Findings provide data to inform future clinical trials on PE for pediatric sepsis.
Abstract:
Pediatric severe sepsis (PSS) is an important cause of death in children. Mortality increases in those with sepsis and multiple organ dysfunction syndrome (MODS). Plasma exchange (PE) has been used as an adjuvant therapy in sepsis, with trials demonstrating variable success. This observational retrospective cohort study aimed to characterize patient demographics, PE use, mortality and resource utilization in septic children from 43 children's hospitals from 2004 to 2012. Of 49,153 PSS cases, 1.8% utilized PE. Utilization increased to 4.8% in those with sepsis and MODS. Comorbidities affected 72-74% of patients. PE patients noted a longer hospitalization than PSS patients (39 vs 17 days). Overall mortality was 14.1% in PSS, increasing to 32.1% in PSS patients receiving PE. Mortality was 22% and 44.4% in PE patients without and with MODS respectively. Mortality decreased over the study period in both PE subgroups. In conclusion, PE utilization in PSS remained stable throughout the study period while PSS mortality decreased over time. Children utilizing PE had a higher associated mortality, but also greater comorbidities and MODS prevalence, likely representing a predilection towards use in more critically ill patients. These data can provide demographic and outcome results to inform future PE trials in sepsis.