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Validation of the pediatric refractory septic shock definition: post hoc analysis of a controlled trial

Luc Morin1, Karthik Narayanan Ramaswamy2, Muralidharan Jayashree2

  • 1Pediatric Intensive Care Unit, Bicêtre Hospital, AP-HP Paris-Saclay University, Le Kremlin-Bicêtre, France.

Annals of Intensive Care
|February 11, 2021
PubMed

Insights

The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) refractory septic shock (RSS) definition accurately identifies children with a lethal outcome within 6 hours. This definition, using bedside and computed septic shock scores (bSSS and cSSS), shows high prognostic accuracy for pediatric septic shock mortality.

Area of Science:

  • Pediatric Intensive Care Medicine
  • Neonatal Intensive Care
  • Septic Shock Research

Background:

  • The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) established a definition for pediatric refractory septic shock (RSS).
  • Both bedside septic shock scores (bSSS) and computed septic shock scores (cSSS) demonstrated a strong correlation with mortality.
  • This study evaluated the accuracy of the ESPNIC RSS definition in a prospective Indian cohort.

Purpose of the Study:

  • To assess the accuracy of the ESPNIC definition of pediatric refractory septic shock (RSS) in a prospective Indian cohort.
  • To determine the prognostic value of the RSS definition for 28-day all-cause mortality in children with septic shock.
  • To evaluate the performance of bedside (bSSS) and computed (cSSS) septic shock scores in identifying high-risk pediatric septic shock patients.

Main Methods:

  • A post hoc analysis was conducted on data from a double-blind randomized trial involving children with septic shock.
  • Sequential bSSS and cSSS data from 60 children were analyzed to assess the ESPNIC RSS definition's prognostic value.
  • The study focused on 28-day all-cause mortality as the primary outcome measure.

Main Results:

  • Refractory septic shock (RSS) was diagnosed in 58.3% of patients within the first 24 hours.
  • Mortality was significantly higher in RSS patients (85.7%) compared to non-RSS patients (8%).
  • Both bSSS and cSSS showed high discrimination for death (AUC 0.916 and 0.925, respectively), with optimal prognostication after 12 hours of treatment.

Conclusions:

  • The ESPNIC refractory septic shock definition effectively identifies children with a high risk of mortality.
  • The definition is accurate within the first 6 hours of managing pediatric septic shock.
  • bSSS and cSSS are valuable tools for predicting outcomes in pediatric septic shock.
Abstract

Keywords:
Cardiac dysfunctionRefractory shockScoreSepsis

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