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Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis
Rajan K Thakkar1, Scott L Weiss2, Julie C Fitzgerald2
1Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Insights
Pediatric postsurgical sepsis has unique mortality risk factors compared to medical sepsis. Identifying these factors, like ward admission, can improve early warning systems for better outcomes in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Sepsis research
Background:
- Sepsis is a major cause of death in children post-surgery, yet often studied without differentiating surgical vs. medical cases.
- Limited data exists on specific risk factors for mortality in pediatric postsurgical sepsis.
- This study addresses the gap by comparing risk factors in pediatric postsurgical sepsis versus medical sepsis.
Purpose of the Study:
- To identify unique risk factors for mortality in pediatric patients with severe sepsis, comparing those with recent surgery (postsurgical sepsis) to those without (medical sepsis).
- To inform the development of targeted early warning systems for pediatric postsurgical sepsis.
Main Methods:
- Secondary analysis of an international point prevalence study involving 128 pediatric intensive care units across 26 countries.
- Categorization of pediatric severe sepsis patients into postsurgical (n=138) and medical (n=418) groups.
- Multivariable logistic regression models were employed to identify independent risk factors for mortality.
Main Results:
- Postsurgical sepsis mortality risk factors included older age, ward admission, multiple organ dysfunction syndrome (MODS), and cardiovascular/respiratory comorbidities.
- Medical sepsis mortality risk factors included resource-limited region, hospital-acquired infection, MODS, higher Pediatric Index of Mortality-3 score, and malignancy.
- Postsurgical patients admitted from the hospital ward had a significantly higher mortality risk.
Conclusions:
- Pediatric postsurgical sepsis and medical sepsis exhibit distinct risk factors for mortality.
- The higher mortality risk associated with ward admission in postsurgical patients highlights a critical area for intervention.
- Findings support the need for developing and testing early warning systems tailored to the pediatric postsurgical sepsis population.
Background:
Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality.
Methods:
Data were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality.
Results:
A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death.
Conclusions:
Pediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population.
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