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Epidemiology of sepsis and multiple organ dysfunction syndrome in children
F Proulx1, M Fayon, C A Farrell
1Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Canada.
Insights
Systemic inflammatory response syndrome (SIRS) and sepsis are common in critically ill children, impacting mortality risk. Secondary multiple organ dysfunction syndrome (MODS) is less frequent but carries higher morbidity and mortality than primary MODS.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Pediatric Critical Illness
Background:
- Systemic inflammatory response syndrome (SIRS), sepsis, and multiple organ dysfunction syndrome (MODS) are significant concerns in critically ill children.
- Understanding the incidence and outcomes of these conditions is crucial for improving pediatric critical care.
Purpose of the Study:
- To determine the incidence of SIRS, sepsis, severe sepsis, septic shock, and MODS in critically ill children.
- To differentiate between primary and secondary MODS and their respective outcomes.
- To assess the association between these conditions and mortality risk.
Main Methods:
- Prospective cohort study conducted in a university hospital's pediatric intensive care unit (PICU).
- Involved 1058 consecutive hospital admissions of critically ill children.
- Data collected on the occurrence of SIRS, sepsis, severe sepsis, septic shock, and MODS, along with mortality and PRISM scores.
Main Results:
- SIRS occurred in 82% of admissions, sepsis in 23%, severe sepsis in 4%, and septic shock in 2%.
- MODS was observed in 16% (primary) and 2% (secondary) of patients. Overall mortality was 6%.
- Higher Pediatric Risk of Mortality (PRISM) scores and increased mortality were associated with sepsis and septic shock. Secondary MODS patients had longer organ dysfunction duration, longer PICU stays, and a significantly higher mortality risk (OR 6.5).
Conclusions:
- SIRS and sepsis are highly prevalent in critically ill children and are linked to distinct mortality risks.
- Secondary MODS, though less common, is associated with substantially increased morbidity and mortality, suggesting different underlying pathophysiological mechanisms compared to primary MODS.
- Further research is needed to elucidate the mechanisms and optimal management of MODS in pediatric populations.
Study Objectives:
To determine the cumulated incidence and the density of incidence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS) in critically ill children; to distinguish patients with primary from those with secondary MODS.
Design:
Prospective cohort study.
Setting:
Pediatric ICU of a university hospital.
Patients:
One thousand fifty-eight consecutive hospital admissions.
Interventions:
None.
Measurements And Results:
SIRS occurred in 82% (n=869) of hospital admissions, 23% (n=245) had sepsis, 4% (n=46) had severe sepsis, 2% (n=25) had septic shock; 16% (n=168) had primary MODS and 2% (n=23) had secondary MODS; 6% (n=68) of the study population died. The pediatric risk of mortality (PRISM) scores on the first day of admission to pediatric ICU were as follows: 3.9 +/- 3.6 (no SIRS), 7.0 +/- 7.0 (SIRS), 9.5 +/- 8.3 (sepsis), 8.8 +/- 7.8 (severe sepsis), 21.8 +/- 15.8 (septic shock); differences among groups (p=0.0001), all orthogonal comparisons, were significant (p<0.05), except for patients with severe sepsis. The observed mortality for the whole study population was also different according to the underlying diagnostic category (p=0.0001; p<0.05 for patients with SIRS and those with septic shock, compared with all groups). Among, patients with MODS, the difference in mortality between groups did not reach significance (p=0.057). Children with secondary MODS had a longer duration of organ dysfunction (p<0.0001), a longer stay in pediatric ICU after MODS diagnosis (p<0.0001), and a higher risk of mortality (odds ratio, 6.5 [2.7 to 15.9], p<0.0001) than patients with primary MODS.
Conclusions:
SIRS and sepsis occur frequently in critically ill children. The presence of SIRS, sepsis, or septic shock is associated with a distinct risk of mortality among critically ill children admitted to the pediatric ICU; more data are needed concerning children with MODS. Secondary MODS is much less common than primary MODS, but it is associated with an increased morbidity and mortality; we speculate that distinct pathophysiologic mechanisms are involved in these two conditions.