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Pediatric Severe Sepsis and Shock in Three Asian Countries: A Retrospective Study of Outcomes in Nine PICUs
Rujipat Samransamruajkit1, Judith Ju-Ming Wong2, Chutima Smathakane3
1Division of Pediatric Critical Care, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Insights
Pediatric severe sepsis and septic shock have high mortality rates in Asia. Most children received guideline-recommended fluid and inotropic support, but outcomes remain poor.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Pediatric sepsis is a significant global health concern, causing substantial mortality and long-term disability.
- Severe sepsis and septic shock in children represent a critical challenge, particularly in Asian healthcare settings.
Purpose of the Study:
- To characterize the epidemiological, therapeutic, and outcome features of pediatric severe sepsis and septic shock.
- To identify factors associated with mortality in children with severe sepsis or septic shock admitted to pediatric intensive care units (PICUs) in Asia.
Main Methods:
- A multicenter retrospective study involving nine multidisciplinary PICUs across three Asian countries.
- Longitudinal clinical data from January to December 2017 for children with severe sepsis or septic shock.
- Multivariable logistic regression analysis to determine predictors of PICU mortality.
Main Results:
- A total of 271 children were analyzed, with pneumonia being the most common infection source.
- The majority of patients received timely resuscitation (within 1 hour) with fluid boluses and vasopressors, primarily normal saline and norepinephrine.
- Overall PICU mortality was 19.2%, with survivors showing improved hemodynamic variables within 6 hours of admission. Admission severity score was linked to mortality.
Conclusions:
- Mortality rates for pediatric severe sepsis and septic shock remain high in Asia.
- Current therapeutic guidelines for fluid therapy and inotropic support were generally followed in the studied PICUs.
- Despite adherence to guidelines, the high mortality underscores the need for further research and improved management strategies.
Objectives:
Pediatric sepsis remains a major health problem and is a leading cause of death and long-term disability worldwide. This study aims to characterize epidemiologic, therapeutic, and outcome features of pediatric severe sepsis and septic shock in three Asian countries.
Design:
A multicenter retrospective study with longitudinal clinical data over 1, 6, 24, 48, and 72 hours of PICU admission. The primary outcome was PICU mortality. Multivariable logistic regression analysis was used to identify factors at PICU admission that were associated with mortality.
Setting:
Nine multidisciplinary PICUs in three Asian countries.
Patients:
Children with severe sepsis or septic shock admitted to the PICU from January to December 2017.
Intervention:
None.
Measurement And Main Results:
A total of 271 children were included in this study. Median (interquartile range) age was 4.2 years (1.3-10.8 yr). Pneumonia (77/271 [28.4%]) was the most common source of infection. Majority of patients (243/271 [90%]) were resuscitated within the first hour, with fluid bolus (199/271 [73.4%]) or vasopressors (162/271 [59.8%]). Fluid resuscitation commonly took the form of normal saline (147/199 [74.2%]) (20 mL/kg [10-20 mL/kg] over 20 min [15-30 min]). The most common inotrope used was norepinephrine 81 of 162 (50.0%). Overall PICU mortality was 52 of 271 (19.2%). Improved hemodynamic variables (e.g., heart rate, blood pressure, and arterial lactate) were seen in survivors within 6 hours of admission as compared to nonsurvivors. In the multivariable model, admission severity score was associated with PICU mortality.
Conclusions:
Mortality from pediatric severe sepsis and septic shock remains high in Asia. Consistent with current guidelines, most of the children admitted to these PICUs received fluid therapy and inotropic support as recommended.
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