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Published on: January 27, 2019
Criteria for Pediatric Sepsis-A Systematic Review and Meta-Analysis by the Pediatric Sepsis Definition Taskforce
Kusum Menon1, Luregn J Schlapbach2, Samuel Akech3
1Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
Insights
Infection in children can lead to sepsis, severe sepsis, or septic shock. Organ dysfunction markers strongly predict mortality in pediatric sepsis cases, informing future diagnostic criteria.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Sepsis is a life-threatening condition in children, characterized by a dysregulated host response to infection.
- Identifying factors associated with sepsis development and mortality is crucial for improving outcomes in pediatric populations.
Purpose of the Study:
- To identify demographic, clinical, laboratory, organ dysfunction, and illness severity variables associated with sepsis, severe sepsis, or septic shock in infected children.
- To determine factors linked to multiple organ dysfunction or death in pediatric patients with sepsis, severe sepsis, or septic shock.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, Embase, Cochrane) from 2004 to 2020.
- Included were case-control, cohort studies, and RCTs involving children (37-week postconception to 18 years) with suspected or confirmed infection and sepsis-related terms.
- Random-effects meta-analysis was performed on data extracted from 106 eligible studies (81 in meta-analysis).
Main Results:
- Infection in children was associated with decreased consciousness and higher Pediatric Risk of Mortality (PRISM) scores for sepsis/severe sepsis.
- For sepsis/severe sepsis/septic shock, mortality was linked to chronic conditions, oncologic diagnosis, vasoactive agents, mechanical ventilation, serum lactate, platelets, fibrinogen, procalcitonin, and various organ dysfunction scores (MODS, P-LODS, PIM-3, PRISM).
- Pooled mortality rates for pediatric sepsis varied significantly by country income level.
Conclusions:
- Markers of organ dysfunction show strong associations with sepsis outcomes in children.
- These findings support the use of identified variables in the data validation phase for the Pediatric Sepsis Definition Taskforce.
- Understanding these associations is vital for refining sepsis definitions and improving clinical management in pediatric patients.
Objective:
To determine the associations of demographic, clinical, laboratory, organ dysfunction, and illness severity variable values with: 1) sepsis, severe sepsis, or septic shock in children with infection and 2) multiple organ dysfunction or death in children with sepsis, severe sepsis, or septic shock.
Data Sources:
MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2004, and November 16, 2020.
Study Selection:
Case-control studies, cohort studies, and randomized controlled trials in children greater than or equal to 37-week-old postconception to 18 years with suspected or confirmed infection, which included the terms "sepsis," "septicemia," or "septic shock" in the title or abstract.
Data Extraction:
Study characteristics, patient demographics, clinical signs or interventions, laboratory values, organ dysfunction measures, and illness severity scores were extracted from eligible articles. Random-effects meta-analysis was performed.
Data Synthesis:
One hundred and six studies met eligibility criteria of which 81 were included in the meta-analysis. Sixteen studies (9,629 patients) provided data for the sepsis, severe sepsis, or septic shock outcome and 71 studies (154,674 patients) for the mortality outcome. In children with infection, decreased level of consciousness and higher Pediatric Risk of Mortality scores were associated with sepsis/severe sepsis. In children with sepsis/severe sepsis/septic shock, chronic conditions, oncologic diagnosis, use of vasoactive/inotropic agents, mechanical ventilation, serum lactate, platelet count, fibrinogen, procalcitonin, multi-organ dysfunction syndrome, Pediatric Logistic Organ Dysfunction score, Pediatric Index of Mortality-3, and Pediatric Risk of Mortality score each demonstrated significant and consistent associations with mortality. Pooled mortality rates varied among high-, upper middle-, and lower middle-income countries for patients with sepsis, severe sepsis, and septic shock (p < 0.0001).
Conclusions:
Strong associations of several markers of organ dysfunction with the outcomes of interest among infected and septic children support their inclusion in the data validation phase of the Pediatric Sepsis Definition Taskforce.
