Journal article
High Levels of Morbidity and Mortality Among Pediatric Hematopoietic Cell Transplant Recipients With Severe Sepsis: Insights From the Sepsis PRevalence, OUtcomes, and Therapies International Point Prevalence Study
Pediatric critical care medicine, Vol.18(12), pp.1114-1125
12/01/2017
DOI: 10.1097/PCC.0000000000001338
PMCID: PMC7339740
PMID: 28926489
Abstract
Objectives: Pediatric severe sepsis is a major cause of morbidity and mortality worldwide, and hematopoietic cell transplant patients represent a high-risk population. We assessed the epidemiology of severe sepsis in hematopoietic cell transplant patients, describing patient outcomes compared with children with no history of hematopoietic cell transplant.
Design: Secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study, comparing demographics, sepsis etiology, illness severity, organ dysfunction, and sepsis-related treatments in patients with and without hematopoietic cell transplant. The primary outcome was hospital mortality. Multivariable logistic regression models were used to determine adjusted differences in mortality.
Setting: International; 128 PICUs in 26 countries.
Patients: Pediatric patients with severe sepsis prospectively identified over a 1-year period.
Interventions: None.
Measurements and Main Results: In patients with severe sepsis, 37/567 (6.5%) had a history of hematopoietic cell transplant. Compared with patients without hematopoietic cell transplant, hematopoietic cell transplant patients had significantly higher hospital mortality (68% vs 23%; p < 0.001). Hematopoietic cell transplant patients were more likely to have hospital acquired sepsis and had more preexisting renal and hepatic dysfunction than non-hematopoietic cell transplant patients with severe sepsis. History of hematopoietic cell transplant, renal replacement therapy, admission from inpatient floor, and number of organ dysfunctions at severe sepsis recognition were independently associated with hospital mortality in multivariable analysis; hematopoietic cell transplant conferred the highest odds of mortality (odds ratio, 4.00; 95% CI, 1.78-8.98). In secondary analysis of hematopoietic cell transplant patients compared with other immunocompromised patients with severe sepsis, history of hematopoietic cell transplant remained independently associated with hospital mortality (odds ratio, 3.03; 95% CI, 1.11-8.27).
Conclusions: In an international study of pediatric severe sepsis, history of hematopoietic cell transplant is associated with a four-fold increased odds of hospital mortality after adjustment for potential measured confounders. Hematopoietic cell transplant patients more often originated from within the hospital compared to children with severe sepsis without hematopoietic cell transplant, possibly providing an earlier opportunity for sepsis recognition and intervention in this high-risk population.
Details
- Title: Subtitle
- High Levels of Morbidity and Mortality Among Pediatric Hematopoietic Cell Transplant Recipients With Severe Sepsis: Insights From the Sepsis PRevalence, OUtcomes, and Therapies International Point Prevalence Study
- Creators
- Robert B. Lindell - Children's Hospital of PhiladelphiaShira J. Gertz - St Barnabas Hosp, Dept Pediat, Livingston, NJ USACourtney M. Rowan - Indiana UniversityJennifer McArthur - St. Jude Children's Research HospitalFlorian Beske - Univ Hosp Schleswig Holstein, Dept Congenital Heart Dis & Pediat Cardiol, Campus Kiel, Kiel, GermanyAdrian Plunkett - Birmingham Children's HospitalScott L. Weiss - Children's Hospital of PhiladelphiaNeal J. Thomas - Pennsylvania State UniversityVinay M. Nadkarni - Children's Hospital of PhiladelphiaJulie C. Fitzgerald - Children's Hospital of PhiladelphiaSepsis Prevalence, Outcomes, and Therapies (SPROUT) Study InvestigatorsPediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
- Contributors
- M Chegondi (Contributor) - University of Iowa, Stead Family Department of PediatricsC Tigges (Contributor) - University of Iowa, Critical Care
- Resource Type
- Journal article
- Publication Details
- Pediatric critical care medicine, Vol.18(12), pp.1114-1125
- DOI
- 10.1097/PCC.0000000000001338
- PMID
- 28926489
- PMCID
- PMC7339740
- NLM abbreviation
- Pediatr Crit Care Med
- ISSN
- 1529-7535
- eISSN
- 1947-3893
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 12
- Grant note
- Therabron ThermoFisher Scientific K23GM110496 / National Institute of General Medical Sciences; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of General Medical Sciences (NIGMS) CareFusion K12HD068371 / EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) Center for Pediatric Clinical Effectiveness at The Children's Hospital of Philadelphia National Institute for Health Research (NIHR) Clinical Research Network; National Institute for Health Research (NIHR) Gene Fluidics Endowed Chair, Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine Southampton by the Southampton NIHR Wellcome Trust Clinical Research Facility Bristol-Meyers Squibb Company
- Language
- English
- Date published
- 12/01/2017
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984353940802771
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