John C Lin1, Philip C Spinella, Julie C Fitzgerald, Marisa Tucci, Jenny L Bush, Vinay M Nadkarni, Neal J Thomas, Scott L Weiss. 1. 1Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.2Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.3Division of Critical Care Medicine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada.4Pediatric Critical Care Medicine, Departments of Pediatrics and Public Health Sciences, Penn State University College of Medicine, Hershey, PA.
Abstract
OBJECTIVES: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. DESIGN: Secondary analysis of a prospective, cross-sectional, point prevalence study. SETTING: International, multicenter PICUs. PATIENTS: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). CONCLUSIONS: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.
OBJECTIVES: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. DESIGN: Secondary analysis of a prospective, cross-sectional, point prevalence study. SETTING: International, multicenter PICUs. PATIENTS: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). CONCLUSIONS: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.
Authors: Oliver Karam; Marisa Tucci; Thierry Ducruet; Heather Anne Hume; Jacques Lacroix; France Gauvin Journal: Pediatr Crit Care Med Date: 2011-09 Impact factor: 3.624
Authors: Lahn Straney; Archie Clements; Roger C Parslow; Gale Pearson; Frank Shann; Jan Alexander; Anthony Slater Journal: Pediatr Crit Care Med Date: 2013-09 Impact factor: 3.624
Authors: Heather E Hsu; Francisca Abanyie; Michael S D Agus; Fran Balamuth; Patrick W Brady; Richard J Brilli; Joseph A Carcillo; Raymund Dantes; Lauren Epstein; Anthony E Fiore; Jeffrey S Gerber; Runa H Gokhale; Benny L Joyner; Niranjan Kissoon; Michael Klompas; Grace M Lee; Charles G Macias; Karen M Puopolo; Carmen D Sulton; Scott L Weiss; Chanu Rhee Journal: Pediatrics Date: 2019-12 Impact factor: 7.124
Authors: Scott L Weiss; Fran Balamuth; Marianne Chilutti; Mark Jason Ramos; Peter McBride; Nancy-Ann Kelly; K Joy Payton; Julie C Fitzgerald; Jeffrey W Pennington Journal: Pediatr Crit Care Med Date: 2020-02 Impact factor: 3.624
Authors: John C Lin; Philip C Spinella; Julie C Fitzgerald; Marisa Tucci; Jenny L Bush; Vinay M Nadkarni; Neal J Thomas; Scott L Weiss Journal: Pediatr Crit Care Med Date: 2017-05 Impact factor: 3.624
Authors: Lauren E Marsillio; Lisa A Asaro; Vijay Srinivasan; David Wypij; Lauren R Sorce; Michael S D Agus; Vinay M Nadkarni Journal: Pediatr Crit Care Med Date: 2019-12 Impact factor: 3.624
Authors: Scott L Weiss; Fran Balamuth; Josey Hensley; Julie C Fitzgerald; Jenny Bush; Vinay M Nadkarni; Neal J Thomas; Mark Hall; Jennifer Muszynski Journal: Pediatr Crit Care Med Date: 2017-09 Impact factor: 3.624
Authors: Scott L Weiss; Fran Balamuth; Cary W Thurm; Kevin J Downes; Julie C Fitzgerald; Benjamin L Laskin Journal: Clin J Am Soc Nephrol Date: 2019-04-18 Impact factor: 8.237
Authors: Jerry J Zimmerman; Russell Banks; Robert A Berg; Athena Zuppa; Christopher J Newth; David Wessel; Murray M Pollack; Kathleen L Meert; Mark W Hall; Michael Quasney; Anil Sapru; Joseph A Carcillo; Patrick S McQuillen; Peter M Mourani; Hector Wong; Ranjit S Chima; Richard Holubkov; Whitney Coleman; Samuel Sorenson; James W Varni; Julie McGalliard; Wren Haaland; Kathryn Whitlock; J Michael Dean; Ron W Reeder Journal: Crit Care Med Date: 2020-03 Impact factor: 7.598
Authors: Joseph A Carcillo; Robert A Berg; David Wessel; Murray Pollack; Kathleen Meert; Mark Hall; Christopher Newth; John C Lin; Allan Doctor; Tom Shanley; Tim Cornell; Rick E Harrison; Athena F Zuppa; Ron W Reeder; Russell Banks; John A Kellum; Richard Holubkov; Daniel A Notterman; J Michael Dean Journal: Pediatr Crit Care Med Date: 2019-12 Impact factor: 3.624