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Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit
Abstract:
Seven hundred twenty-six patients from five pediatric intensive care units were studied to determine the association of multiple organ system failure (MOSF) with mortality and to test the hypothesis that MOSF associated with sepsis has a higher mortality rate than MOSF without sepsis. There were 177 (24%) patients with MOSF and 83 (11%) nonsurvivors of MOSF. The mortality rates for two, three, or four or more failed organ systems were 26%, 62%, and 88%, respectively (P less than 0.001). Eighty-four (47%) patients with MOSF had associated sepsis. Sepsis (both bacteremia and clinical sepsis syndrome) did not significantly increase mortality rates in the groups with organ system failure. Mortality rates for patients with sepsis before or within 24 hours of development of MOSF (early sepsis) did not differ from mortality rates for those patients with onset of sepsis more than 24 hours after developing MOSF (late sepsis, 53% vs 33%, P = NS). We conclude that underlying pathophysiologic mechanisms of MOSF other than sepsis are as important as sepsis in critically ill pediatric patients.
Insights
Multiple organ system failure (MOSF) in critically ill children significantly increases mortality risk. Sepsis did not notably impact MOSF mortality rates, suggesting other underlying mechanisms are equally important.
Area of Science:
- Pediatric critical care medicine
- Intensive care unit (ICU) outcomes
- Sepsis and organ failure research
Background:
- Multiple organ system failure (MOSF) is a critical condition in pediatric intensive care units (PICUs).
- Understanding the association between MOSF, sepsis, and mortality is crucial for improving patient outcomes.
- Previous hypotheses suggested sepsis significantly elevates mortality in MOSF patients.
Purpose of the Study:
- To determine the association between MOSF and mortality in pediatric ICU patients.
- To test if MOSF with sepsis carries a higher mortality rate than MOSF without sepsis.
- To compare mortality rates based on the timing of sepsis onset relative to MOSF development.
Main Methods:
- A retrospective study of 726 patients from five PICUs.
- Analysis of mortality rates in patients with varying degrees of MOSF (2, 3, or 4+ failed organ systems).
- Comparison of mortality between MOSF patients with and without sepsis, and evaluation of early vs. late sepsis onset.
Main Results:
- 177 (24%) patients experienced MOSF, with 83 (11%) nonsurvivors.
- Mortality increased significantly with the number of failed organ systems: 26% (2 systems), 62% (3 systems), and 88% (4+ systems).
- Sepsis (bacteremia or clinical sepsis syndrome) did not significantly increase mortality in MOSF patients. Early vs. late sepsis onset also showed no significant difference in mortality (53% vs. 33%).
Conclusions:
- MOSF is strongly associated with increased mortality in critically ill children.
- Sepsis does not appear to be a primary driver of increased mortality in pediatric MOSF.
- Underlying pathophysiologic mechanisms of MOSF, beyond sepsis, are critical factors in pediatric ICU mortality.