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Association of Pathogen Type With Outcomes of Children Encountering Community-Acquired Pediatric Septic Shock
Derek Salud1, Ron W Reeder2, Russell K Banks2
1Touro College of Osteopathic Medicine, New York, NY.
Insights
Pediatric septic shock outcomes, including mortality and functional status, were similar across different pathogen types. However, pathogen type may influence intensive care unit resource utilization.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
Background:
- Pediatric septic shock is a life-threatening condition with significant morbidity and mortality.
- Understanding the role of specific pathogens in pediatric septic shock outcomes is crucial for targeted treatment and resource allocation.
Purpose of the Study:
- To investigate the association between pathogen type and clinical outcomes in children hospitalized with septic shock.
- To determine if pathogen type influences mortality, functional status, and health-related quality of life (HRQL) at hospital discharge or one month post-hospitalization.
Main Methods:
- Secondary analysis of a prospective, descriptive cohort study involving 389 children (1 month to 18 years) with septic shock across twelve US pediatric intensive care units (PICUs).
- Outcomes assessed included mortality, functional morbidity, and HRQL at 1 month post-discharge.
- Statistical analysis examined associations between pathogen types (no organism, viral, bacterial/fungal, coinfection) and clinical outcomes, controlling for age.
Main Results:
- No statistically significant differences in composite outcomes of mortality or substantial new functional morbidity were observed across different pathogen types.
- Similarly, no significant differences were found for mortality or persistent serious deterioration of health-related quality of life (HRQL) based on pathogen type.
- Significant associations were identified between pathogen type and the duration of mechanical ventilation (ventilator-free days) and PICU length of stay (PICU-free days).
Conclusions:
- Pathogen type was not significantly associated with composite mortality and morbidity outcomes in pediatric septic shock.
- Pathogen type may influence the utilization of PICU resources, such as ventilator and length of stay.
- Pediatric septic shock is frequently linked to adverse, clinically meaningful outcomes irrespective of the infectious agent identified.
Objectives:
To determine the association of pathogen type with mortality, functional status, and health-related quality of life (HRQL) among children at hospital discharge/1 month following hospitalization for septic shock.
Design:
Secondary database analysis of a prospective, descriptive cohort investigation.
Setting:
Twelve academic PICUs in the United States.
Patients:
Critically ill children, 1 month to 18 years old, enrolled from 2013 to 2017.
Interventions:
None.
Measurements And Main Results:
Association of clinical outcomes with pathogen type was assessed for all patients and separately for surviving patients enrolled in the primary Life After Pediatric Sepsis Evaluation (LAPSE) investigation. For this secondary analysis, we predicted that age would be associated with pathogen type and outcomes, and accordingly, it was incorporated as a confounding variable in primary analyses. Among 389 children enrolled with septic shock, at 1 month/hospital discharge, we observed no statistically significant differences in relation to pathogen types for the composite outcome mortality or substantial new functional morbidity: no causative organism identified (27% [28/103]), pure viral infections (26% [24/91]), pure bacterial/fungal infections (25% [31/125]), and bacterial/fungal+viral coinfections (33% [23/70]). Similarly, we observed no statistically significant differences in relation to pathogen types for the composite outcome, mortality, or persistent serious deterioration of HRQL: no causative organism identified (43% [44/103]), pure viral infections (33% [30/91]), pure bacterial/fungal infections (46% [57/125]), and bacterial/fungal+viral coinfections (43% [30/70]). However, we did identify statistically significant associations between pathogen type and the outcome ventilator-free days ( p = 0.0083) and PICU-free days (0.0238).
Conclusions:
This secondary analysis of the LAPSE database identified no statistically significant association of pathogen type with composite mortality and morbidity outcomes. However, pathogen type may be associated with PICU resources employed to treat sepsis organ dysfunction. Ultimately, pediatric septic shock was frequently associated with adverse patient-centered, clinically meaningful outcomes regardless of infectious disease pathogen type.
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