Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

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

doi: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

Pediatrics

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

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 language	English (US)
Pages (from-to)	100-110
Number of pages	11
Journal	Journal of Surgical Research
Volume	242
DOIs	https://doi.org/10.1016/j.jss.2019.04.011
State	Published - Oct 2019

Funding

R.K.T. was supported by National Institute of Health 1K08GM124499-01A1 ; S.L.W. was also supported by National Institute of Health K23GM110496 . R.K.T. was supported by National Institute of Health 1K08GM124499-01A1; S.L.W. was also supported by National Institute of Health K23GM110496. Authors’ contributions: R.K.T. S.L.W. J.C.F. N.J.T. V.M.N. and M.W.H. conceived the study. R.K.T. S.L.W. J.C.F. L.K. N.J.T. V.M.N. and M.W.H. participated in the design of the study. R.K.T. S.L.W. J.C.F. L.K. N.J.T. V.M.N. J.A.M. M.W.H. participated in data collection. R.K.T. S.L.W. L.K. J.A.M. M.W.H. performed the statistical analyses. R.K.T. S.L.W. J.C.F. N.J.T. V.M.N. J.A.M. and M.W.H. helped to draft the article. All authors read and approved the final article. Drs Thakkar, Weiss, Fitzgerald, Keele, Thomas, Nadkarni, Muszynski, and Hall had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Financial support was provided by the Division of Critical Care and the Center for Pediatric Clinical Effectiveness at The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine. The authors also appreciate the financial support of the Research Institute at Nationwide Children's Hospital along Department of Surgery and Division of Critical Care Medicine at Nationwide Children's Hospital. The authors thank the World Federation of Pediatric Intensive and Critical Care Societies for help in site recruitment. They are grateful to all local investigators at participating SPROUT sites for their contributions to this study. SPROUT study investigators: North America: Canada: P. Fontela (Montreal Children's Hospital-McGill), M. Tucci, M. Dumistrascu (Sainte Justine Hospital), P. Skippen, G. Krahn (BC Children's Hospital); Puerto Rico: E. Bezares (Hospital Cardiovascular de Puerto Rico y el Caribe), G. Puig, A. Puig-Ramos (San Jorge Children's Hospital), R. Garcia, M. Villar (University Pediatric Hospital); United States: M. Bigham, T. Polanski, S. Latifi, D. Giebner, H. Anthony (Akron Children's Hospital), J. Hume, A. Galster, L. Linnerud (Amplatz Children's Hospital), R. Sanders, G. Hefley (Arkansas Children's Hospital), K. Madden (Boston Children's Hospital), A. Thompson, S. Shein (Children's Hospital of Pittsburgh), S. Gertz (Children's Hospital-Hackensack), Y. Han, T. Williams, A. Hughes-Schalk (Children's Mercy Hospital), H. Chandler (Children's Healthcare of Atlanta), A. Orioles, E. Zielinski, A. Doucette (Children's Hospital in Minnesota), A. Orioles, E. Zielinski, A. Doucette (Children's Hospital St. Paul), C. Zebuhr, T. Wilson (Children's Hospital Colorado), C. Dimitriades, J. Ascani, S. Layburn, S. Valley (Children's Hospital New Orleans), B. Markowitz, J. Terry, R. Morzov (Children's Hospital of Los Angeles), A. Mcinnes (Children's Hospital of Monmouth), J. McArthur, K. Woods, K. Murkowski (Children's Hospital of Wisconsin), M. Spaeder, M. Sharron (Children's National Medical Center), D. Wheeler, E. Beckman, E. Frank, K. Howard (Cincinnati Children's Medical Center), C. Carroll (Connecticut Children's), S. Nett, D. Jarvis (Dartmouth Hitchcock), V. Patel (Dayton Children's Hospital), R. Higgerson, L. Christie (Dell Children's Medical Center), K. Typpo, J. Deschenes (Diamond Children's Hospital), A. Kirby (Doernbecher Children's Hospital), T. Uhl, K. Rehder, I. Cheifetz, S. Wrenn (Duke Children's Hospital), K. Kypuros (El Paso Children's Hospital), K. Ackerman (Golisano Children's Hospital), F. Maffei, G. Bloomquist (Janet Weis/Geisinger), N. Rizkalla (Johns Hopkins), D. Kimura, S. Shah, C. Tigges (Le Bonheur Children's Hospital), F. Su, C. Barlow (Lucile Packard Children's Hospital), K. Michelson, K. Wolfe, D. Goodman, L. Campbell, L. Sorce (Lurie Children's Hospital of Chicago), K. Bysani, T. Monjure (Medical City Children's-Dallas), M. Evans (Medical University of South Carolina), B. Totapally, M. Chegondi, C. Rodriguez (Miami Children's Hospital), J. Frazier, L. Steele (Nationwide Children's Hospital), S. Viteri, A. Costarino (Nemours/Alfred I. duPont Children's Hospital), N. Thomas, D. Spear (Penn State Hershey Medical Center), E. Hirshberg, J. Lilley (Primary Children's Medical Center), C. Rowan, C. Rider (Riley Hospital for Children), J. Kane (Rush Children's Hospital), J. Zimmerman, C. Greeley (Seattle Children's Hospital), J. Lin, R. Jacobs (St. Louis Children's Hospital), M. Parker, K. Culver (Stony Brook University), L. Loftis, N. Jaimon, M. Goldsworthy (Texas Children's Hospital), J. Fitzgerald, S. Weiss, V. Nadkarni, J. Bush, M. Diliberto (The Children's Hospital of Philadelphia), C. Allen, M. Gessouroun (Oklahoma University Medical Center), A. Sapru, T. Lang, M. Alkhouli (University of California San Francisco), S. Kamath, D. Friel, J. Daufeldt (University of Iowa), D. Hsing, C. Carlo, S. Pon (Weill Cornell Medical Center), J. Scimeme, A. Shaheen (Wolfson Children's Hospital), A. Hassinger, H. Qiao (Women and Children's Hospital of Buffalo), J. Giuliano, J. Tala (Yale Children's Hospital). South America: Argentina: D. Vinciguerra, A. Fernandez (Hospital Durand); Colombia: R. Carrero (Clínica Infantil Colsubsidio), P. Hoyos (Hospital de San Jose), J. Jaramillo, A. Posada (Hospital General de Medellín), L. Izquiierdo (Hospital Military Central), B.E. Piñeres Olave, J. Donado (Pablo Tobón Uribe); Chile: R. Dalmazzo, S. Rendich (Clínica Las Condes), L. Palma, M. Lapadula (Clínica Santa María), C. Acuna (Hospital Luis Calvo Mackenna), P. Cruces (Hospital Padre Hurtado) Europe: Belgium: S. Clement De Clety, M. Dujardin, C. Berghe, S. Renard (St. Luc University Hospital); Czech Republic: J. Zurek (Masaryk University); Germany: H. Steinherr (Klinikum Augsburg); Greece: K. Mougkou (Aghia Sophia Children's Hospital), E. Critselis, K. Mougkou (P. & A. Kyriakou Children's Hospital); Italy: M. Di Nardo, S. Picardo, F. Tortora (Bambino Gesu Area Rossa); E. Rossetti (Bambino Gesu Children's Hospital); T. Fragasso, P. Cogo, R. Netto (Bambino Gesu Pediatrico); Lithuania: A. Dagys, V. Gurskis, R. Kevalas (Lithuanian University of Health Sciences); Netherlands: C. Neeleman, J. Lemson, C. Luijten (Radboud University Medical Center); Poland: K. Wojciech, I. Pagowska-Klimek (Polish Mother Memorial Hospital), M. Szczepanska, J. Karpe (Szyszko Śląskiego University); Portugal: P. Nunes, H. Almeida (Hospital Prof Dr Fernando Fonseca), J. Rios, M. Vieira (Centrol Hospitalar Lisboa Norte); Spain: J. P. Garcia Iniguez, P. Revilla (Children's Hospital Miguel Servet), J. Urbano, J. Lopez-Herce, A. Bustinza (Hospital General Universitario Gregorio Marañón), A. Palacios, S. Hofheinz(Hospital 12 de Octubre), A. Rodriguez-Nunez (Hospital Clínico Universitario), S. Sanagustin, E. Gonzalez (Hospital de la Sant Creu Sant Pau), M. Riaza, R. Piaya (Hospital Universitario Madrid), P. Soler (Hospital Carlos Haya Materno Infantil), E. Esteban (Hospital Sant Joan de Déu), J. Laraudogoitia, C. Monge (Hospital Universitario Donostia), V. Herrera, J. Granados (Hospital Universitario Salamanca), C. Gonzalez (Hospital Virgen de la Arrixaca); Turkey: T. Koroglu, E. Ozcelik (Dokuz Eylul University); United Kingdom: P. Baines (Alder Hey Children's Hospital), A. Plunkett (Birmingham Children's Hospital), P. Davis, S. George (Bristol Royal Hospital for Children), S. Tibby, J. Harris (Evelina Children's Hospital), R. Agbeko, R. Lampitt (Great North Children's Hospital–Newcastle), J. Brierley, M. Peters, A. Jones, T. Dominguez, T. Thiruchelvam, (Great Ormond Street), A. Deep, L. Ridley, W. Bowen (King's College Hospital), R. Levin, I. Macleod (Royal Hospital for Sick Children), M. Gray, N. Hemat (St George's Hospital), J. Alexander, S. Ali (University Hospital of North Staffordshire NHS Trust), J. Pappachan, J. McCorkell (University Hospital Southampton NHS Foundation Trust), P. Fortune, M. MacDonald, P. Hudnott (Royal Manchester Children's Hospital). Asia: China: Q. Suyun (Beijing Children's Hospital); India: S. Singhi, K. Nallasamy (Advanced Pediatrics), R. Lodha (All India Institute); Japan: N. Shime, Y. Tabata (Kyoto Prefectural), O. Saito, T. Ikeyama (Tokyo Metropolitan), T. Kawasaki (Shizuoka Children's Hospital); Malaysia: L. Lum, A. Abidin, S. Kee (University Malaya Medical Center), S. Tang, R. Jalil (Kebangsaan Malaysia Medical Center); Singapore: Y. Guan, L. Yao (KK Women's and Children's Hospital), K. Lin, J. Ong (National University Hospital). Africa: South Africa: A. Salloo, L. Doedens, L. Mathivha (Chris Hani Baragwanath), G. Reubenson, S. Moaisi (Rahima Moosa), A. Pentz, R. Green (Steve Biko Academic Hospital). Australia: A. Schibler, A. Fernandez (Mater Children's Hospital), S. Erickson (Princess Margaret Hospital), J. McEneiry, D. Long, T. Dorofaeff, M. Coulthard (Royal Children's Hospital Brisbane), J. Millar, C. Delzoppo (Royal Children's Melbourne), G. Williams, M. Morritt (Sydney Children's Hospital), N. Watts, M. Morritt (Children's Hospital Westmead). New Zealand: J. Beca, C. Sherring, T. Bushell (Starship Children's Hospital). Drs Thakkar, Weiss, Fitzgerald, Keele, Thomas, Nadkarni, Muszynski, and Hall had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Financial support was provided by the Division of Critical Care and the Center for Pediatric Clinical Effectiveness at The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine . The authors also appreciate the financial support of the Research Institute at Nationwide Children's Hospital along Department of Surgery and Division of Critical Care Medicine at Nationwide Children's Hospital .

Keywords

Medical sepsis
Mortality
Pediatric sepsis
Surgical sepsis

ASJC Scopus subject areas

Surgery

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10.1016/j.jss.2019.04.011

Cite this

@article{5a816c3ac9064eb6a212c825ad947a8c,

title = "Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis",

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.",

keywords = "Medical sepsis, Mortality, Pediatric sepsis, Surgical sepsis",

author = "{SPROUT Investigators} and {Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network} and Thakkar, {Rajan K.} and Weiss, {Scott L.} and Fitzgerald, {Julie C.} and Luke Keele and Thomas, {Neal J.} and Nadkarni, {Vinay M.} and Muszynski, {Jennifer A.} and Hall, {Mark W.} 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. Giebner 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 S. Gertz 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 D. Wheeler and K. Michelson and K. Wolfe and D. Goodman",

note = "Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = oct,

doi = "10.1016/j.jss.2019.04.011",

language = "English (US)",

volume = "242",

pages = "100--110",

journal = "Journal of Surgical Research",

issn = "0022-4804",

publisher = "Academic Press Inc.",

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TY - JOUR

T1 - Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

AU - SPROUT Investigators

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 - Wheeler, D.

AU - Michelson, K.

AU - Wolfe, K.

AU - Goodman, D.

PY - 2019/10

Y1 - 2019/10

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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UR - http://www.scopus.com/inward/citedby.url?scp=85065059180&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2019.04.011

DO - 10.1016/j.jss.2019.04.011

M3 - Article

C2 - 31075654

AN - SCOPUS:85065059180

SN - 0022-4804

VL - 242

SP - 100

EP - 110

JO - Journal of Surgical Research

JF - Journal of Surgical Research

ER -

Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

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