Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

Thakkar, R. K.; Weiss, S. L.; Fitzgerald, J. C.; Keele, L.; Thomas, N. J.; Nadkarni, V. M.; Muszynski, J. A.; Hall, M. W.; Fontela, P.; Tucci, M.; Dumistrascu, M.; Skippen, P.; Krahn, G.; Bezares, E.; Puig, G.; Puig-Ramos, A.; Garcia, R.; Villar, M.; Bigham, M.; Polanski, T.; Latifi, S.; Giebner, D.; Anthony, H.; Hume, J.; Galster, A.; Linnerud, L.; Sanders, R.; Hefley, G.; Madden, K.; Thompson, A.; Shein, S.; Gertz, S.; Han, Yangyang; Williams, T.; Hughes-Schalk, A.; Chandler, H.; Orioles, A.; Zielinski, E.; Doucette, A.; Zebuhr, C.; Wilson, T.; Dimitriades, C.; Ascani, J.; Layburn, S.; Valley, S.; Markowitz, B.; Terry, J.; Morzov, R.; Mcinnes, A.; Mcarthur, J.; Woods, K.; Murkowski, K.; Spaeder, M.; Sharron, M.; Wheeler, D.; Beckman, E.; Frank, E.; Howard, K.; Carroll, C.; Nett, S.; Jarvis, D.; Patel, V.; Higgerson, R.; Christie, L.; Typpo, K.; Deschenes, J.; Kirby, A.; Uhl, T.; Rehder, K.; Cheifetz, I.; Wrenn, S.; Kypuros, K.; Ackerman, K.; Maffei, F.; Bloomquist, G.; Rizkalla, N.; Kimura, D.; Shah, S.; Tigges, C.; Su, F.; Barlow, C.; Michelson, K.; Wolfe, K.; Goodman, D.; Campbell, L.; Sorce, L.; Bysani, K.; Monjure, T.; Evans, M.; Totapally, B.; Chegondi, M.; Rodriguez, C.; Frazier, J.; Steele, L.; Viteri, S.; Costarino, A.; Thomas, N.; Spear, D.; Hirshberg, E.; Lilley, J.; Rowan, C.; Rider, C.; Kane, J.; Zimmerman, J.; Greeley, C.; Lin, J.; Jacobs, R.; Parker, M.; Culver, K.; Loftis, L.; Jaimon, N.; Goldsworthy, M.; Fitzgerald, J.; Weiss, S.; Nadkarni, V.; Bush, J.; Diliberto, M.; Allen, C.; Gessouroun, M.; Sapru, A.; Lang, T.; Alkhouli, M.; Kamath, S.; Friel, D.; Daufeldt, J.; Hsing, D.; Carlo, C.; Pon, S.; Scimeme, J.; Shaheen, Asma; Hassinger, A.; Qiao, H.; Giuliano, J.; Tala, J.; Vinciguerra, D.; FERNANDEZ BARALDO, GUSTAVO ADOLFO; Carrero, R.; Hoyos, P.; Jaramillo, J.; Posada, A.; Izquiierdo, L.; Olave, B. E. P.; Donado, J.; Dalmazzo, R.; Rendich, S.; Palma, L.; Lapadula, M.; Acuna, C.; Cruces, P.; De Clety, S. C.; Dujardin, M.; Berghe, C.; Renard, S.; Zurek, J.; Steinherr, H.; Mougkou, K.; Critselis, E.; Di Nardo, M.; Picardo, S.; Tortora, F.; Rossetti, E.; Fragasso, T.; Cogo, P.; Netto, R.; Dagys, A.; Gurskis, V.; Kevalas, R.; Neeleman, C.; Lemson, J.; Luijten, C.; Wojciech, K.; Pagowska-Klimek, I.; Szczepanska, M.; Karpe, J.; Nunes, P.; Almeida, H.; Rios, J.; Vieira, M.; Iniguez, J. P. G.; Revilla, P.; Urbano, J.; Lopez-Herce, J.; Bustinza, A.; Palacios, A.; Hofheinz, S.; Rodriguez-Nunez, A.; Sanagustin, S.; Gonzalez, E.; Riaza, M.; Piaya, R.; Soler, P.; Esteban, E.; Laraudogoitia, J.; Monge, C.; Herrera, V.; Granados, J.; Gonzalez, C.; Koroglu, T.; Ozcelik, E.; Baines, P.; Plunkett, A.; Davis, P.; George, S.; Tibby, S.; Harris, J.; Agbeko, R.; Lampitt, R.; Brierley, J.; Peters, M.; Jones, A.; Dominguez, T.; Thiruchelvam, T.; Deep, A.; Ridley, L.; Bowen, W.; Levin, R.; Macleod, I.; Gray, M.; Hemat, N.; Alexander, J.; Ali, S.; Pappachan, J.; Mccorkell, J.; Fortune, P.; Macdonald, M.; Hudnott, P.; Suyun, Q.; Singhi, S.; Nallasamy, K.; Lodha, R.; Shime, N.; Tabata, Y.; Saito, O.; Ikeyama, T.; Kawasaki, T.; Lum, L.; Abidin, A.; Kee, S.; Tang, S.; Jalil, R.; Guan, Y.; Yao, L.; Lin, K.; Ong, J.; Salloo, A.; Doedens, L.; Mathivha, L.; Reubenson, G.; Moaisi, S.; Pentz, A.; Green, R.; Schibler, A.; Erickson, S.; Mceneiry, J.; Long, D.; Dorofaeff, T.; Coulthard, M.; Millar, J.; Delzoppo, C.; Williams, G.; Morritt, M.; Watts, N.; Beca, J.; Sherring, C.; Bushell, T.

doi:10.1016/j.jss.2019.04.011

Background: 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. Methods: Data were extracted from a secondary analysis of an international point preva- lence 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. Results: 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 comor- bidities 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. Conclusions: Pediatric patients with postsurgical sepsis had different risk factors for mor- tality 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.