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

Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1114-1125
Number of pages12
JournalPediatric Critical Care Medicine
Volume18
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Sepsis
Cross-Sectional Studies
Pediatrics
Morbidity
Transplants
Mortality
Hospital Mortality
Therapeutics
Transplant Recipients
Logistic Models
Odds Ratio
Renal Replacement Therapy
Immunocompromised Host
Population
Inpatients
Epidemiology
Demography

Keywords

  • epidemiology
  • hematopoietic cell transplantation
  • immunocompromised host
  • multiple organ dysfunction syndrome
  • severe sepsis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

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. / Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

In: Pediatric Critical Care Medicine, Vol. 18, No. 12, 01.12.2017, p. 1114-1125.

Research output: Contribution to journalArticle

Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. / 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. In: Pediatric Critical Care Medicine. 2017 ; Vol. 18, No. 12. pp. 1114-1125.
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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.",
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author = "{Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network} and Lindell, {Robert B.} and Gertz, {Shira J.} and Rowan, {Courtney M.} and Jennifer McArthur and Florian Beske and Adrian Plunkett and Weiss, {Scott L.} and Thomas, {Neal J.} and Nadkarni, {Vinay M.} and Fitzgerald, {Julie C.} and P. Fontela and M. Tucci and M. Dumistrascu and P. Skippen and G. Krahn and E. Bezares and G. Puig and A. Puig-Ramos and R. Garcia and M. Villar and M. Bigham and T. Polanski and S. Latifi and D. Giebne and H. Anthony and J. Hume and A. Galster and L. Linnerud and R. Sanders and G. Hefley and K. Madden and A. Thompson and S. Shein and Y. Han and T. Williams and A. Hughes-Schalk and H. Chandler and A. Orioles and E. Zielinski and A. Doucette and C. Zebuhr and T. Wilson and C. Dimitriades and J. Ascani and S. Layburn and S. Valley and B. Markowitz and J. Terry and R. Morzov and Typpo, {Katri V}",
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TY - JOUR

T1 - High Levels of Morbidity and Mortality among Pediatric Hematopoietic Cell Transplant Recipients with Severe Sepsis

T2 - Insights from the Sepsis PRevalence, OUtcomes, and Therapies International Point Prevalence Study

AU - Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

AU - Lindell, Robert B.

AU - Gertz, Shira J.

AU - Rowan, Courtney M.

AU - McArthur, Jennifer

AU - Beske, Florian

AU - Plunkett, Adrian

AU - Weiss, Scott L.

AU - Thomas, Neal J.

AU - Nadkarni, Vinay M.

AU - Fitzgerald, Julie C.

AU - Fontela, P.

AU - Tucci, M.

AU - Dumistrascu, M.

AU - Skippen, P.

AU - Krahn, G.

AU - Bezares, E.

AU - Puig, G.

AU - Puig-Ramos, A.

AU - Garcia, R.

AU - Villar, M.

AU - Bigham, M.

AU - Polanski, T.

AU - Latifi, S.

AU - Giebne, D.

AU - Anthony, H.

AU - Hume, J.

AU - Galster, A.

AU - Linnerud, L.

AU - Sanders, R.

AU - Hefley, G.

AU - Madden, K.

AU - Thompson, A.

AU - Shein, S.

AU - Han, Y.

AU - Williams, T.

AU - Hughes-Schalk, A.

AU - Chandler, H.

AU - Orioles, A.

AU - Zielinski, E.

AU - Doucette, A.

AU - Zebuhr, C.

AU - Wilson, T.

AU - Dimitriades, C.

AU - Ascani, J.

AU - Layburn, S.

AU - Valley, S.

AU - Markowitz, B.

AU - Terry, J.

AU - Morzov, R.

AU - Typpo, Katri V

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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.

AB - 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.

KW - epidemiology

KW - hematopoietic cell transplantation

KW - immunocompromised host

KW - multiple organ dysfunction syndrome

KW - severe sepsis

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U2 - 10.1097/PCC.0000000000001338

DO - 10.1097/PCC.0000000000001338

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JO - Pediatric Critical Care Medicine

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