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Published on: January 27, 2019
Comparison between hospital- and community-acquired septic shock in children: a single-center retrospective cohort
Guo-Yun Su1,2, Chao-Nan Fan1,2, Bo-Liang Fang1,2
1Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nan-Li-Shi Road, Beijing, 100045, China.
Insights
Hospital-acquired septic shock (HASS) in children has higher mortality than community-acquired septic shock (CASS). Risk factors for mortality also differ significantly between HASS and CASS pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Septic shock in children presents distinct challenges based on its origin, whether acquired in the hospital or community.
- Understanding these differences is crucial for effective management and improved outcomes in pediatric intensive care units (PICUs).
Purpose of the Study:
- To compare baseline characteristics, pathogens, complications, outcomes, and risk factors between hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in pediatric patients.
- To identify specific predictors of mortality for each type of pediatric septic shock.
Main Methods:
- A retrospective study was conducted on pediatric patients diagnosed with septic shock in a PICU.
- Patients were categorized into HASS and CASS groups and followed for 28-day mortality.
- Logistic regression analysis was employed to determine risk factors for mortality.
Main Results:
- The study included 298 children; HASS patients (65.9%) often had hematologic/oncologic diseases and Gram-negative infections, while CASS patients (67.7%) had fewer underlying conditions and more Gram-positive infections.
- 28-day mortality was significantly higher in HASS (62.6%) compared to CASS (32.7%).
- Risk factors for HASS mortality included low platelet count, positive pathogen detection, and multiple organ dysfunction syndrome. For CASS, risk factors were elevated lactate and mechanical ventilation.
Conclusions:
- Significant variations exist in underlying conditions, pathogens, complications, prognosis, and mortality rates between pediatric HASS and CASS.
- The identified predictors of 28-day mortality are distinct for HASS and CASS pediatric patients, highlighting the need for tailored treatment strategies.
Background:
We explored the differences in baseline characteristics, pathogens, complications, outcomes, and risk factors between children with hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in the pediatric intensive care unit (PICU).
Methods:
This retrospective study enrolled children with septic shock at the PICU of Beijing Children's Hospital from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into the HASS and CASS group. Logistic regression analysis was used to identify risk factors for mortality.
Results:
A total of 298 children were enrolled. Among them, 65.9% (n = 91) of HASS patients had hematologic/oncologic diseases, mainly with Gram-negative bacterial bloodstream infections (47.3%). Additionally, 67.7% (n = 207) of CASS patients had no obvious underlying disease, and most experienced Gram-positive bacterial infections (30.9%) of the respiratory or central nervous system. The 28-day mortality was 62.6% and 32.7% in the HASS and CASS groups, respectively (P < 0.001). Platelet [odds ratio (OR) = 0.996, 95% confidence interval (CI) = 0.992-1.000, P = 0.028], positive pathogen detection (OR = 3.557, 95% CI = 1.307-9.684, P = 0.013), and multiple organ dysfunction syndrome (OR = 10.953, 95% CI = 1.974-60.775, P = 0.006) were risk factors for 28-day mortality in HASS patients. Lactate (OR = 1.104, 95% CI = 1.022-1.192, P = 0.012) and mechanical ventilation (OR = 8.114, 95% CI = 1.806-36.465, P = 0.006) were risk factors for 28-day mortality in patients with CASS.
Conclusions:
The underlying diseases, pathogens, complications, prognosis, and mortality rates varied widely between the HASS and CASS groups. The predictors of 28-day mortality were different between HASS and CASS pediatric patients with septic shock.
