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Timing and predictors of death in pediatric patients with multiple organ system failure
F Proulx1, M Gauthier, D Nadeau
1Department of Pediatrics, Ste-Justine Hospital, Université de Montréal, PQ, Canada.
Insights
Pediatric patients with multiple organ system failure have a high mortality rate. Key risk factors for death include the number of organ failures, age under 12 months, and the PRISM score.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Pediatric Critical Illness
Background:
- Multiple organ system failure (MOSF) is a critical condition in pediatric intensive care units (ICUs).
- Understanding the timing and risk factors for mortality in pediatric MOSF is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the onset of organ system failure, MOSF diagnosis, and death timing in pediatric ICU patients.
- To identify independent risk markers for mortality in pediatric patients diagnosed with MOSF.
Main Methods:
- A retrospective database review of 777 pediatric patients (<18 years) admitted to a tertiary care pediatric ICU.
- Analysis of the timing of organ system failures, MOSF diagnosis, and death, along with multivariate analysis to identify risk factors.
Main Results:
- MOSF occurred in 10.9% of patients, with 43.5% being postoperative cardiac surgery patients.
- MOSF diagnosis and peak organ failures typically occurred early (within 72 hours of admission).
- The overall mortality rate for pediatric MOSF was 50.6%, with most deaths occurring within 7 days of diagnosis. Independent risk factors for death included the maximum number of simultaneous organ failures, age ≤12 months, and the Pediatric Risk of Mortality (PRISM) score.
Conclusions:
- Pediatric MOSF is associated with a high mortality rate.
- Early identification of risk factors such as the number of organ failures, young age, and PRISM score is vital.
- The early onset of MOSF and subsequent death suggests a need to re-evaluate the timing and efficacy of prophylactic therapies.
Objectives:
To describe the timing of onset of organ system failure, multiple organ system failure diagnosis, and the subsequent death in children admitted to a pediatric intensive care unit (ICU). Second, to identify independent risk markers of death in pediatric patients with multiple organ system failure.
Design:
Review of a database.
Setting:
Pediatric ICU within a tertiary care center.
Patients:
We analyzed the pediatric ICU course of 777 consecutive patients aged < 18 yrs.
Measurements And Main Results:
Eighty-five (10.9%) of 777 children had multiple organ system failure, defined as the simultaneous occurrence of at least two organ system failures. Of 85 children, 37 (43.5%) were postoperative cardiac surgery patients and 48 (56.5%) patients were in the ICU for other reasons. The diagnostic criteria for multiple organ system failure were met on the day of admission by 73 (86%) of 85 patients. The maximum number of organ system failures occurred within 72 hrs in 74 (87%) children. The mortality rate for all patients with multiple organ system failure was 50.6%. Thirty-eight (88.4%) of deaths occurred within 7 days after the diagnosis of multiple organ system failure. Survival analysis was comparable for both postoperative cardiac surgery patients and patients with other diagnoses. Multivariate analysis identified three factors as independent risk markers of death in pediatric patients with multiple organ system failure: maximum number of simultaneous organ system failures during the pediatric ICU stay: odds ratio, 55.9 (95% confidence interval, 7.9 to 396.1); age < or = 12 months: odds ratio, 17.1 (95% confidence interval, 1.8 to 158.7); and the Pediatric Risk of Mortality (PRISM) score on the day of admission: odds ratio, 1.25 (95% confidence interval, 1.1 to 1.5).
Conclusions:
The mortality rate associated with multiple organ system failure in pediatric patients is high. The maximum number of simultaneous organ system failures during pediatric ICU stay, age < or = 12 months, and the PRISM score on the day of admission are independent risk markers of death. Diagnosis of multiple organ system failures, development of maximum number of organ system failures, and deaths occur remarkably early after pediatric ICU admission; the rationale for using prophylactic therapy under such circumstances is unclear.