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 language | English (US) |
|---|---|
| Pages (from-to) | 1114-1125 |
| Number of pages | 12 |
| Journal | Pediatric Critical Care Medicine |
| Volume | 18 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2017 |
Funding
1Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, St. Barnabas Medical Center, Livingston, NJ. 3Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN. 4Department of Pediatric Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN. 5Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany. 6Paediatric Intensive Care Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom. 7Department of Pediatrics, Penn State Hershey Children’s Hospital, Penn State University College of Medicine, Hershey, PA. The Sepsis PRevalence, OUtcomes, and Therapies study was supported by the Endowed Chair, Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, and the Center for Pediatric Clinical Effectiveness at The Children’s Hospital of Philadelphia. Financial support for data collection in all U.K. centers was provided by the National Institute for Health Research (NIHR) Clinical Research Network and in Southampton by the Southampton NIHR Wellcome Trust Clinical Research Facility. None of the funders participated in the design and conduct of study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the article. Dr. Weiss’ institution received funding from National Institute of General Medical Sciences K23GM110496, and he received funding from Bristol-Meyers Squibb Company (Advisory Panel) and ThermoFisher Scientific (honorarium for lecture). Dr. Thomas’ institution received funding from Gene Fluidics, and he received funding from CareFusion and Therabron. Dr. Fitzgerald’s institution received funding from Center for Pediatric Clinical Effectiveness at the Children’s Hospital of Philadelphia. The remaining authors have disclosed that they do not have any potential conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).
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