Outcomes of Day 1 Multiple Organ Dysfunction Syndrome in the PICU
Katri Typpo1, R Scott Watson2,3, Tellen D Bennett4
1Division of Pediatric Critical Care Medicine, Department of Pediatrics and the Steele Children's Research Center, University of Arizona, Tucson, AZ.
Insights
Multiple Organ Dysfunction Syndrome present on day 1 of PICU admission significantly increases mortality risk. While neurological outcomes may improve, further research is needed on life-support decisions for these critically ill children.
Area of Science:
- Pediatric critical care medicine
- Clinical outcomes research
- Pediatric critical illness
Background:
- Multiple Organ Dysfunction Syndrome (MODS) is a significant concern in Pediatric Intensive Care Units (PICUs).
- Understanding the outcomes of MODS present at the time of PICU admission is crucial for patient management and prognosis.
- Day 1 MODS is associated with increased morbidity and mortality in critically ill children.
Purpose of the Study:
- To describe the current outcomes of pediatric patients with Multiple Organ Dysfunction Syndrome (MODS) identified on day 1 of Pediatric Intensive Care Unit (PICU) admission.
- To evaluate the association between day 1 MODS and mortality, as well as functional status at discharge.
- To explore the role of limitation of support decisions in patients with day 1 MODS.
Main Methods:
- Retrospective observational cohort study utilizing the Virtual Pediatric Systems database (2014-2015).
- Analysis of 194,017 PICU admissions (age 1 month to 18 years).
- Identification of day 1 MODS using International Pediatric Sepsis Consensus Conference criteria and assessment of functional status using Pediatric Overall Performance Category (PC) and Pediatric Cerebral Performance Category (CPC) scores.
Main Results:
- Overall PICU mortality was 2.1%, with 14.4% of admissions having day 1 MODS.
- Patients with day 1 MODS had significantly higher mortality (10.3% vs 0.7%) and worse functional outcomes (higher PC/CPC score worsening) compared to those without MODS.
- Limitation of support decisions were more frequent in patients with day 1 MODS, particularly among those who died.
Conclusions:
- Day 1 MODS remains a substantial contributor to mortality and morbidity in the PICU.
- While neurological outcomes may show potential for improvement, the risk of death is significantly elevated.
- Further investigation into decisions regarding limitation of support and withdrawal of life-sustaining therapies in day 1 MODS patients is warranted.
Objectives:
We sought to describe current outcomes of Multiple Organ Dysfunction Syndrome present on day 1 of PICU admission.
Design:
Retrospective observational cohort study.
Setting:
Virtual Pediatric Systems, LLC, database admissions, January 2014 and December 2015.
Patients:
We analyzed 194,017 consecutive PICU admissions, (age 1 mo to 18 yr) from the 2014-2015 Virtual Pediatric Systems database.
Interventions:
We identified day 1 Multiple Organ Dysfunction Syndrome by International Pediatric Sepsis Consensus Conference criteria with day 1 laboratory and vital sign values. Functional status was evaluated by Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores from PICU admission and discharge.
Measurements And Main Results:
Overall, PICU mortality was 2.1%. We identified day 1 Multiple Organ Dysfunction Syndrome in 14.4% of admissions. Patients with Multiple Organ Dysfunction Syndrome had higher mortality than those without Multiple Organ Dysfunction Syndrome (10.3% vs 0.7%; p < 0.0001), and a higher percentage of survivors had greater than or equal to 2 category worsening in Pediatric Cerebral Performance Category score (3.6% vs 0.5%; p < 0.0001) or Pediatric Overall Performance Category score (6.0% vs 1.8%; p < 0.0001). The odds of death with day 1 Multiple Organ Dysfunction Syndrome was 14.3 (95% CI, 13-15.7), while the odds of death or discharge with Pediatric Overall Performance Category/Pediatric Cerebral Performance Category score greater than or equal to 3 (poor functional outcome) was 6.7 (95% CI, 6-7.4). In a subset of 148,188 patients from hospitals where limitation of support decisions were recorded, 5.8% patients with Multiple Organ Dysfunction Syndrome had limitation of support decisions in place, compared with 0.8% of patients without Multiple Organ Dysfunction Syndrome (p < 0.0001). Of day 1 Multiple Organ Dysfunction Syndrome patients who died, 43.1% had limitation of support decisions in place, and 41.6% had withdrawal of life-sustaining therapies (p < 0.0001).
Conclusions:
Multiple Organ Dysfunction Syndrome present on day 1 of admission continues to be a major source of morbidity and mortality in the PICU, but risk of poor neurologic outcome may be improved. Further research is needed to understand decisions regarding limitation of support and withdrawal of life-sustaining therapy decisions in patients admitted with day 1 Multiple Organ Dysfunction Syndrome.
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