Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

SPROUT Investigators, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Research output: Contribution to journalArticle

Abstract

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 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. 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 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)100-110
Number of pages11
JournalJournal of Surgical Research
Volume242
DOIs
StatePublished - Oct 1 2019

Fingerprint

Sepsis
Pediatrics
Mortality
Multiple Organ Failure
Logistic Models
Pediatric Intensive Care Units
Cross Infection
Intensive Care Units
Comorbidity
Cross-Sectional Studies

Keywords

  • Medical sepsis
  • Mortality
  • Pediatric sepsis
  • Surgical sepsis

ASJC Scopus subject areas

  • Surgery

Cite this

SPROUT Investigators, & Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (2019). Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis. Journal of Surgical Research, 242, 100-110. https://doi.org/10.1016/j.jss.2019.04.011

Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis. / SPROUT Investigators; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

In: Journal of Surgical Research, Vol. 242, 01.10.2019, p. 100-110.

Research output: Contribution to journalArticle

SPROUT Investigators & Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network 2019, 'Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis', Journal of Surgical Research, vol. 242, pp. 100-110. https://doi.org/10.1016/j.jss.2019.04.011
SPROUT Investigators, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis. Journal of Surgical Research. 2019 Oct 1;242:100-110. https://doi.org/10.1016/j.jss.2019.04.011
SPROUT Investigators ; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. / Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis. In: Journal of Surgical Research. 2019 ; Vol. 242. pp. 100-110.
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abstract = "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 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. 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 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. Conclusions: 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.",
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AU - Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

AU - Thakkar, Rajan K.

AU - Weiss, Scott L.

AU - Fitzgerald, Julie C.

AU - Keele, Luke

AU - Thomas, Neal J.

AU - Nadkarni, Vinay M.

AU - Muszynski, Jennifer A.

AU - Hall, Mark W.

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 - Giebner, 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 - Gertz, 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 - Mcinnes, A.

AU - Typpo, Katri V

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N2 - 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 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. 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 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. Conclusions: 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.

AB - 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 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. 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 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. Conclusions: 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.

KW - Medical sepsis

KW - Mortality

KW - Pediatric sepsis

KW - Surgical sepsis

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