Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study

Hauschild, Daniela Barbieri; Oliveira, Luna Dias de Almeida; Ventura, Julia Carvalho; Farias, Mirelle Sifroni; Barbosa, Eliana; Bresolin, Nilzete Liberato; Moreno, Yara Maria Franco

doi:10.1111/jhn.12798

Cited by 8 publications

(3 citation statements)

References 37 publications

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“…Details of the concepts included in case definitions of pediatric CCI are summarized in Supplemental Content D (http://links.lww.com/PCC/C264) and detailed in Supplemental Content E (http://links.lww.com/PCC/C264). Of the 12 studies describing a definition for pediatric CCI, two were based solely on PICU length of stay (LOS) exceeding 14 days (30) or 28 days (11), respectively. The remaining 10 studies defined CCI based on a combination of concepts related to chronicity and complexity.…”

Section: Resultsmentioning

confidence: 99%

“…Of these, five studies cited the same source (10), and one study cited a source that did not report any definition for pediatric CCI (86). The definition of CCI in one study, based on prolonged PICU admission alone, was derived by a statistical method, using a receiver operating curve for the outcome of overall mortality (area under the curve, 0.70; sensitivity, 0.50; specificity, 0.85) (30). The remaining five studies did not describe the rationale for their definitions.…”

Section: Rationale For Definitionsmentioning

confidence: 99%

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Defining Pediatric Chronic Critical Illness: A Scoping Review*

Zorko

McNally

Rochwerg

et al. 2022

Pediatric Critical Care Medicine

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Children with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literature for case definitions of pediatric CCI and case definitions of prolonged PICU admission and to explore the methodologies used to derive these definitions.DATA SOURCES: Four electronic databases (Ovid Medline, Embase, CINAHL, and Web of Science) from inception to March 3, 2021. STUDY SELECTION:We included studies that provided a specific case definition for CCI or prolonged PICU admission. Crowdsourcing was used to screen citations independently and in duplicate. A machine-learning algorithm was developed and validated using 6,284 citations assessed in duplicate by trained crowd reviewers. A hybrid of crowdsourcing and machine-learning methods was used to complete the remaining citation screening. DATA EXTRACTION:We extracted details of case definitions, study demographics, participant characteristics, and outcomes assessed.DATA SYNTHESIS: Sixty-seven studies were included. Twelve studies (18%) provided a definition for CCI that included concepts of PICU length of stay (n = 12), medical complexity or chronic conditions (n = 9), recurrent admissions (n = 9), technology dependence (n = 5), and uncertain prognosis (n = 1). Definitions were commonly referenced from another source (n = 6) or opinion-based (n = 5). The remaining 55 studies (82%) provided a definition for prolonged PICU admission, most frequently greater than or equal to 14 (n = 11) or greater than or equal to 28 days (n = 10). Most of these definitions were derived by investigator opinion (n = 24) or statistical method (n = 18). CONCLUSIONS: Pediatric CCI has been variably defined with regard to the concepts of patient complexity and chronicity of critical illness. A consensus definition is needed to advance this emerging and important area of pediatric critical care research.

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Section: Resultsmentioning

confidence: 99%

Section: Rationale For Definitionsmentioning

confidence: 99%

Defining Pediatric Chronic Critical Illness: A Scoping Review*

Zorko

McNally

Rochwerg

et al. 2022

Pediatric Critical Care Medicine

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“…The association between UN and inferior PICU outcomes might be explained by a depleted metabolic store with a high catabolic state, low nutritional intake or decreased absorption efficacy ( 38 , 39 ), loss of muscle mass and strength affecting respiratory function ( 40 , 41 ), as well as impaired immunity and high oxidative stress associated with delayed wound healing and increased infection risks ( 40 , 42 ). Thus, in future studies nutrition states must be evaluated during the whole PICU period rather than at admission.…”

Section: Discussionmentioning

confidence: 99%

Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review

Albadi

Bookari

2022

Front. Pediatr.

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Background and aimUndernutrition (UN) may negatively impact clinical outcomes for hospitalized patients. The relationship between UN status at pediatric intensive care unit (PICU) admission and clinical outcomes is still not well-reported. This systematic meta-analysis review evaluated the impact of UN at admission to PICU on clinical outcomes, including mortality incidence, length of stay (LOS), and the need for and length of time on mechanical ventilation (MV).MethodsA search was conducted using relevant and multi-medical databases from inception until January 2022. We considered studies that examined the link between UN at PICU admission and clinical outcomes in patients aged 18 years or younger. Pooled risk difference estimates for the PICU outcomes were calculated using a random-effects model.ResultThere were a total of 10,638 patients included in 17 observational studies; 8,044 (75.61%) and 2,594 (24.38%) patients, respectively, were normal-nourished (NN) and undernourished (UN). In comparison to NN patients, UN patients had a slightly higher risk of mortality (RD = 0.02, P = 0.05), MV usage (RD = 0.05, P = 0.02), and PICU LOS (RD = 0.07, P = 0.007). While the duration of MV was significantly longer in UN than in NN (RD = 0.13, P < 0.0001). Sensitivity analysis of UN classification cohorts with a z-score < -2 or in the 5%, patetints age up to 18 years, and mixed diagnose for PICU admission demonstrated a 6-fold increase in the probability of PICU LOS in UN patients compared to NN patients (RD = 0.06, 95% CI = 0.01, 0.12). UN patients have a higher risk of MV usage RD = 0.07, 95% CI = 0.00, 0.14) in studies involving cohorts with a mixed primary diagnosis for PICU admission.ConclusionIn PICU, UN is linked to mortality incidence, longer PICU stay, MV usage, and duration on MV. The primary diagnosis for PICU admission may also influence clinical outcomes. Determining the prevalence of UN in hospitalized patients, as well as the subgroups of patients diagnosed at the time of admission, requires more research. This may help explain the relationship between nutritional status and clinical outcomes in PICU patients.

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