Journal Article

Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS)

Boeddha, Navin P., Klobassa, Daniela S., Driessen, Gertjan J., Agbeko, Rachel S., Hazelzet, Jan A., Cebey-López, Miriam, Herberg, Jethro A., Carrol, Enitan D., Inwald, David P., Fink, Colin G., Secka, Fatou, Philipsen, Ria, Berger, Christoph, Emonts, Marieke, Rivero-Calle, Irene, Pinnock, Eleanor, Nadel, Simon, Paulus, Stéphane, Zenz, Werner, Martinón-Torres, Federico, Levin, Michael, Schlapbach, Luregn J., van der Flier, Michiel, de Groot, Ronald, Anderson, Suzanne T.

2018

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Analysis / Analysis of Variance / Bacteremia / Bacterial infections / Chi-Square Distribution / Child / Child, Preschool / Childhood / Children / Cohort analysis / Cohort Studies / Community-Acquired Infections - epidemiology / Community-Acquired Infections - mortality / Critical care / Critical Care Medicine / Diseases / Emergency Medicine / Europe / Europe - epidemiology / Female / Health risk assessment / Humans / Immunization / Infant / Intensive / Intensive Care Units, Pediatric - organization & administration / Intensive Care Units, Pediatric - statistics & numerical data / Male / Medicine / Medicine & Public Health / Meningococcal infections / Morbidity / Mortality / Pediatrics / Pneumococcal infections / Prospective Studies / Risk factors / Sepsis / Sepsis - epidemiology / Sepsis - mortality / Statistics, Nonparametric / Streptococcus infections / Vaccines