TY - JOUR
T1 - Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units
T2 - a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS)
AU - Boeddha, Navin P
AU - EUCLIDS Consortium
AU - Schlapbach, Luregn J
AU - Driessen, Gertjan J
AU - Herberg, Jethro A
AU - Rivero-Calle, Irene
AU - Cebey-López, Miriam
AU - Klobassa, Daniela S
AU - Philipsen, Ria
AU - de Groot, Ronald
AU - Inwald, David P
AU - Nadel, Simon
AU - Paulus, Stéphane
AU - Pinnock, Eleanor
AU - Secka, Fatou
AU - Anderson, Suzanne T
AU - Agbeko, Rachel S
AU - Berger, Christoph
AU - Fink, Colin G
AU - Carrol, Enitan D
AU - Zenz, Werner
AU - Levin, Michael
AU - van der Flier, Michiel
AU - Martinón-Torres, Federico
AU - Hazelzet, Jan A
AU - Emonts, Marieke
AU - van de Beek, Diederik
PY - 2018/5/31
Y1 - 2018/5/31
N2 - BACKGROUND: Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability.METHODS: Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis.RESULTS: Patients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1-16.0, P = 0.04; disability OR 5.4, 95% CI 1.8-15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3-6.1, P < 0.01; disability OR 3.4, 95% CI 1.8-6.4, P < 0.001).CONCLUSIONS: Despite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.
AB - BACKGROUND: Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability.METHODS: Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis.RESULTS: Patients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1-16.0, P = 0.04; disability OR 5.4, 95% CI 1.8-15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3-6.1, P < 0.01; disability OR 3.4, 95% CI 1.8-6.4, P < 0.001).CONCLUSIONS: Despite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.
KW - Adolescent
KW - Analysis of Variance
KW - Chi-Square Distribution
KW - Child
KW - Child, Preschool
KW - Cohort Studies
KW - Community-Acquired Infections/epidemiology
KW - Europe/epidemiology
KW - Female
KW - Humans
KW - Infant
KW - Intensive Care Units, Pediatric/organization & administration
KW - Male
KW - Prospective Studies
KW - Sepsis/epidemiology
KW - Statistics, Nonparametric
U2 - https://doi.org/10.1186/s13054-018-2052-7
DO - https://doi.org/10.1186/s13054-018-2052-7
M3 - Article
C2 - 29855385
SN - 1364-8535
VL - 22
SP - 143
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
ER -