The Association of Nutrition Status Expressed as Body Mass Index z Score With Outcomes in Children With Severe Sepsis: A Secondary Analysis From the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study*

Irving, Sharon Y.; Daly, Bridget; Verger, Judy; Brown, A; Hanlon, Alexandra L.; Weiss, Scott L.; Fitzgerald, Julie C.; Nadkarni, Vinay; Thomas, Neal J.; Srinivasan, Vijay; Fontela, Patricia; Tucci, Marisa; Dumis-trascu, M.; Skippen, Peter; Krahn, Gordon; Bezares, E.; Puig, Gilberto; Puig-Ramos, Anabel; Garcia, Richard U.; Villar, Miguęl; Bigham, Michael T.; Polanski, T.; Latifi, Samir; Giebner, D.; Anthony, Heather; Hume, Janet R.; Galster, A.; Linnerud, L.; Sanders, Ronald C.; Hefley, Glenda; Madden, Kate; Thompson, Anne; Shein, Steven L.; Gertz, Shira J.; Han, Yong; Williams, Tatjana; Hughes-Schalk, A.; Chandler, Heather K.; Orioles, Alberto; Zielinski, Erin E.; Doucette, Abigail; Zebuhr, Carleen; Wilson, Tremika LeShan; Dimitriades, Constantine; Ascani, J.; Layburn, S.; Valley, S.; Markowitz, B.; Terry, John B.; Morzov, Rica; McInnes, A.; McArthur, Jennifer; Woods, Katherine; Murkowski, Kathleen; Spaeder, Michael C.; Sharron, Matthew; Wheeler, Derek S.; Beckman, Eileen; Frank, Erin; Howard, Kelli; Carroll, Christopher L.; Nett, Sholeen; Jarvis, Déborah; Patel, Vihas; Higgerson, Renee A.; Christie, LeeAnn M.; Typpo, Katri; Deschenes, Jen; Kirby, Aileen; Uhl, Tammy L.; Rehder, Kyle J; Cheifetz, Ira M.; Wrenn, Steven P.; Kypuros, K.; Ackerman, Kurt D.; Maffei, Frank A.; Bloomquist, G.; Rizkalla, Nicole; Kimura, Dai; Shah, Sachin S; Tigges, Christian; Su, Fam Po Joen; Barlow, Carolyn E.; Michelson, Kelly; Wolfe, K.S.; Goodman, Denise M.; Campbell, Lesley V.; Sorce, Lauren R.; Bysani, Kaethan; Monjure, Tracey; Evans, Matthew C.; Totapally, Balagangadhar; Chegondi, Madhuradhar; Rodríguez, Carlos Valenzuela; Frazier, Joshua; Steele, Lisa; Viteri, Shirley; Costarino, Andrew T.

doi:10.1097/ccm.0000000000003351

Cited by 30 publications

(22 citation statements)

References 39 publications

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“…BMI has long been considered to be one of the strongest risk factors for serious and critical illness. As researches [ 30 – 32 ] shown, for intensive care unit patients receiving endotracheal intubation, higher BMI was correlated with higher mortality and longer length of stay. Liu et al [ 33 ] reported that severe patients with COVID-19 had higher BMI.…”

Section: Discussionmentioning

confidence: 99%

Combination of serum lactate dehydrogenase and sex is predictive of severe disease in patients with COVID-19

Zhou

Dong

et al. 2020

Medicine

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Elevated serum lactate dehydrogenase (LDH) was commonly reported in COVID-19 patients. However, the relationship between LDH and the incidence of severe cases has not been characterized in those patients. We retrospectively analyzed the characteristics of patients from a designated isolation medical center for COVID-19 patients diagnosed from February 6 to March 1. Variables accessed within 48 hours on admission were compared between patients with and without the severe disease. Logistic model analyses were performed to examine the prognostic value of LDH for predicting severe disease. 52 (28.6%) patients later developed severe disease. Comparing to non-severe cases, severe cases had a higher level of serum LDH (321.85 ± 186.24 vs 647.35 ± 424.26, P < .001), neutrophils (5.42 ± 3.26 vs 9.19 ± 6.33, P < .001), and C-reactive protein (38.63 ± 43.14 vs 83.20 ± 51.01, P < .001). The patients with severe disease tended to be male (44.6% vs 80.8%, P < .001), lower level of serum albumin (31.41 ± 6.20 vs 27.18 ± 5.74, P < .001), and SpO2 (96.30 ± 2.75 vs 92.37 ± 8.29, P < .001). In the multivariate analysis model, LDH and sex remained independent risk factors for severe disease. The serum LDH predicted severe cases with an area under the curve (AUC) of 0.7999. A combination of serum LDH and sex predicted severe cases with an AUC of 0.849. A combination of serum LDH accessed on admission and sex had a better predictive performance than the serum LDH ( P = .0238). Serum LDH on admission combined with sex is independently associated with severe disease in COVID-19.

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Section: Discussionmentioning

confidence: 99%

Combination of serum lactate dehydrogenase and sex is predictive of severe disease in patients with COVID-19

Zhou

Dong

et al. 2020

Medicine

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“…True validity of the AMC against a “gold standard,” such as SGA, has not yet been published and is clearly needed. Notwithstanding the need for further validation work, the use of the AMC and the PMI tools has been useful in measuring malnutrition in hospitalized adult and pediatric patients and linking that condition with important clinical outcomes, including mortality, hospital length of stay (adults), complications (pediatrics), and readmissions . .…”

Section: Discussionmentioning

confidence: 99%

“…In the pediatric population, similar results have been observed with 3 published studies to date evaluating malnutrition as identified by the PMI and outcomes (see Table 6). [46][47][48] Increased odds of 30-day complications following surgery in children with Crohn's disease was demonstrated in those identified as mildly, moderately, or severely malnourished using the z-score BMI single indicator. 46 This was observed only in mild (OR = 2.1 [P = 0.04]) and severely (OR 3.3 [P = 0.03]) malnourished patients.…”

Section: Malnutrition Characteristics and Outcomesmentioning

confidence: 99%

“…47 Higher all-cause ICU mortality (adjusted OR 3.0, 95% CI 1.2-7.7, P = 0.02) was demonstrated in those severely malnourished defined with the single zscore BMI indicator in an international pediatric severely septic cohort. 48…”

Section: Malnutrition Characteristics and Outcomesmentioning

confidence: 99%

“…In a tertiary children's hospital, odds of unplanned readmissions within 7 days of a previous discharge were higher in those malnourished and younger ( P = 0.002) . Higher all‐cause ICU mortality (adjusted OR 3.0, 95% CI 1.2–7.7, P = 0.02) was demonstrated in those severely malnourished defined with the single z ‐score BMI indicator in an international pediatric severely septic cohort …”

Section: Introductionmentioning

confidence: 95%

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Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Usability and Association With Outcomes

et al. 2019

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Malnutrition has been documented in approximately one‐third of patients in developed countries on hospital admission and is associated with negative clinical outcomes. The need to identify and intervene in at‐risk patients is critical to minimize these negative outcomes. A consensus approach for diagnosing and documenting malnutrition in hospitalized adult and pediatric patients was published jointly by the Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) in 2012 and 2014, respectively. The purpose of this paper is to review the available literature on the usability, feasibility, validity, and reliability of both the adult and pediatric consensus malnutrition diagnostic approaches, as well as to evaluate their use in studying clinical outcomes. In adults, abstracts and published studies have shown the diagnostic tool is a usable, feasible, and reliable method for the identification of severe and non‐severe or moderate malnutrition. In pediatrics, only 1 published study to date used the pediatric malnutrition indicators, indicating the need to demonstrate that the tool is feasible, valid, and reliable. Both the adult and pediatric tools have shown significant correlation with negative clinical outcomes in malnourished patients, including increased mortality, increased hospital length of stay (adults), increased complications (pediatrics), and increased hospital readmissions. Further large‐scale studies are needed to evaluate the feasibility, usability, validity, and reliability of both the adult and pediatric malnutrition diagnostic approaches.

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Viral DNAemia and DNA Virus Seropositivity and Mortality in Pediatric Sepsis

Cabler,

Storch,

Weinberg

et al. 2024

JAMA Netw Open

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ImportanceSepsis is a leading cause of pediatric mortality. Little attention has been paid to the association between viral DNA and mortality in children and adolescents with sepsis.ObjectiveTo assess the association of the presence of viral DNA with sepsis-related mortality in a large multicenter study.Design, Setting, and ParticipantsThis cohort study compares pediatric patients with and without plasma cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus 1 (HSV-1), human herpesvirus 6 (HHV-6), parvovirus B19 (B19V), BK polyomavirus (BKPyV), human adenovirus (HAdV), and torque teno virus (TTV) DNAemia detected by quantitative real-time polymerase chain reaction or plasma IgG antibodies to CMV, EBV, HSV-1, or HHV-6. A total of 401 patients younger than 18 years with severe sepsis were enrolled from 9 pediatric intensive care units (PICUs) in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Data were collected from 2015 to 2018. Samples were assayed from 2019 to 2022. Data were analyzed from 2022 to 2023.Main Outcomes and MeasuresDeath while in the PICU.ResultsAmong the 401 patients included in the analysis, the median age was 6 (IQR, 1-12) years, and 222 (55.4%) were male. One hundred fifty-four patients (38.4%) were previously healthy, 108 (26.9%) were immunocompromised, and 225 (56.1%) had documented infection(s) at enrollment. Forty-four patients (11.0%) died in the PICU. Viral DNAemia with at least 1 virus (excluding TTV) was detected in 191 patients (47.6%) overall, 63 of 108 patients (58.3%) who were immunocompromised, and 128 of 293 (43.7%) who were not immunocompromised at sepsis onset. After adjustment for age, Pediatric Risk of Mortality score, previously healthy status, and immunocompromised status at sepsis onset, CMV (adjusted odds ratio [AOR], 3.01 [95% CI, 1.36-6.45]; P = .007), HAdV (AOR, 3.50 [95% CI, 1.46-8.09]; P = .006), BKPyV (AOR. 3.02 [95% CI, 1.17-7.34]; P = .02), and HHV-6 (AOR, 2.62 [95% CI, 1.31-5.20]; P = .007) DNAemia were each associated with increased mortality. Two or more viruses were detected in 78 patients (19.5%), with mortality among 12 of 32 (37.5%) who were immunocompromised and 9 of 46 (19.6%) who were not immunocompromised at sepsis onset. Herpesvirus seropositivity was common (HSV-1, 82 of 246 [33.3%]; CMV, 107 of 254 [42.1%]; EBV, 152 of 251 [60.6%]; HHV-6, 253 if 257 [98.4%]). After additional adjustment for receipt of blood products in the PICU, EBV seropositivity was associated with increased mortality (AOR, 6.10 [95% CI, 1.00-118.61]; P = .049).Conclusions and RelevanceThe findings of this cohort study suggest that DNAemia for CMV, HAdV, BKPyV, and HHV-6 and EBV seropositivity were independently associated with increased sepsis mortality. Further investigation of the underlying biology of these viral DNA infections in children with sepsis is warranted to determine whether they only reflect mortality risk or contribute to mortality.

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The Association of Nutrition Status Expressed as Body Mass Index z Score With Outcomes in Children With Severe Sepsis: A Secondary Analysis From the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study*

Cited by 30 publications

References 39 publications

Combination of serum lactate dehydrogenase and sex is predictive of severe disease in patients with COVID-19

Combination of serum lactate dehydrogenase and sex is predictive of severe disease in patients with COVID-19

Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Usability and Association With Outcomes

Viral DNAemia and DNA Virus Seropositivity and Mortality in Pediatric Sepsis

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