Journal article
Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis
The Journal of surgical research, Vol.242, pp.100-110
10/2019
DOI: 10.1016/j.jss.2019.04.011
PMID: 31075654
Abstract
Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality.
Data were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality.
A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death.
Pediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population.
Details
- Title: Subtitle
- Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis
- Creators
- Rajan K Thakkar - The Ohio State UniversityScott L Weiss - Philadelphia UniversityJulie C Fitzgerald - Philadelphia UniversityLuke Keele - University of PennsylvaniaNeal J Thomas - Pennsylvania State UniversityVinay M Nadkarni - Philadelphia UniversityJennifer A Muszynski - The Ohio State UniversityMark W Hall - The Ohio State UniversitySepsis PRevalence, OUtcomes, and Therapies (SPROUT) InvestigatorsPediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
- Contributors
- M Chegondi (Contributor) - University of Iowa, Stead Family Department of Pediatrics
- Resource Type
- Journal article
- Publication Details
- The Journal of surgical research, Vol.242, pp.100-110
- DOI
- 10.1016/j.jss.2019.04.011
- PMID
- 31075654
- ISSN
- 0022-4804
- eISSN
- 1095-8673
- Grant note
- DOI: 10.13039/100000002, name: National Institute of Health, award: 1K08GM124499-01A1; DOI: 10.13039/100000002, name: National Institute of Health, award: K23GM110496; name: Division of Critical Care; name: Center for Pediatric Clinical Effectiveness; name: The Children's Hospital of Philadelphia; name: University of Pennsylvania Perelman School of Medicine; name: Research Institute at Nationwide Children's Hospital; DOI: 10.13039/100007520, name: Nationwide Children's Hospital
- Language
- English
- Date published
- 10/2019
- Academic Unit
- Stead Family Department of Pediatrics
- Record Identifier
- 9984354119802771
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