Timing and predictors of death in pediatric patients with multiple organ system failure

Proulx, François; Gauthier, Marie; Nadeau, Daniel; Lacroix, Jacques; Farrell, Catherine

doi:10.1097/00003246-199406000-00023

Cited by 190 publications

(142 citation statements)

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“…We may have also missed some cases of new or progressive multiorgan dysfunction by measuring organ dysfunction for only 7 instead of 28 days following sepsis recognition. However, any underestimate is likely to be small because more than 95% of organ dysfunction in pediatric sepsis has been shown to develop within 7 days (33), and this approach greatly improved efficiency of data collection. Additionally, although we compiled one of the largest cohorts of prospectively identified pediatric severe sepsis cases to date, the sample was not sufficient to compare outcomes according to etiology of infection or use of therapies other than corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“…The day of severe sepsis recognition was identified by retrospectively reviewing the medical charts to determine the first calendar day on which a patient met consensus criteria for severe sepsis (16). The presence of new or progressive multiorgan dysfunction syndrome (MODS) was measured for 7 days following severe sepsis recognition according to previously published criteria (20,33). For severity of illness, the Pediatric Index of Mortality (PIM)-3 score (34) was calculated at PICU admission, and the Pediatric Logistic Organ Dysfunction score (35) was collected on the study day.…”

Section: Data Collectionmentioning

confidence: 99%

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Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

Weiss

Fitzgerald

Pappachan

et al. 2015

Am J Respir Crit Care Med

848

625

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Rationale: Limited data exist about the international burden of severe sepsis in critically ill children.Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials.Methods: A point prevalence study was conducted on 5 days throughout 2013-2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator-and vasoactive-free days at Day 28, functional status, and mortality.Measurements and Main Results: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6-8.9%). The patients' median age was 3.0 (interquartile range [IQR], 0.7-11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resourcelimited countries. Median ventilator-free days were 16 (IQR, 0-25), and vasoactive-free days were 23 (IQR,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5-10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,437 patients per group.Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

Weiss

Fitzgerald

Pappachan

et al. 2015

Am J Respir Crit Care Med

848

625

View full text Add to dashboard Cite

show abstract

“…Severity of illness was calculated using the PRISM III score (27). Organ failure was defined according to previously published criteria (28)(29)(30), and for the purposes of this study, AKI was defined as a blood urea nitrogen (BUN) concentration > 100 mg/dL, serum creatinine > 2 mg/dL in the absence of pre-existing renal disease, or the need for dialysis (28)(29)(30). Annotated clinical and laboratory data were collected daily while in the PICU.…”

Section: Patientsmentioning

confidence: 99%

Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock

Wheeler

Devarajan²,

Ma³

et al. 2008

Critical Care Medicine

304

182

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Objective-To validate serum neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for acute kidney injury (AKI) in critically ill children with septic shock.Design-Observational cohort study. Setting-15 North American pediatric intensive care units (PICU).Patients-A total of 143 critically ill children with SIRS or septic shock and 25 healthy controls. Interventions-None.Measurements and Main Results-Serum NGAL was measured during the first 24 hours of admission to the PICU. AKI was defined as a blood urea nitrogen (BUN) concentration > 100 mg/ dL, serum creatinine > 2 mg/dL in the absence of pre-existing renal disease, or the need for dialysis. There was a significant difference in serum NGAL between healthy children (median 80 ng/mL, IQR 55.5-85.5 ng/mL), critically ill children with SIRS (median 107.5 ng/mL, IQR 89-178.5 ng/mL), and critically ill children with septic shock (median 302 ng/mL, IQR 151-570 ng/mL; p<0.001). AKI developed in 22 out of 143 (15.4%) critically ill children. Serum NGAL was significantly increased in critically ill children with AKI (median 355 ng/mL, IQR 166-1322 ng/mL) compared to those without AKI (median 186 ng/mL, IQR 98-365 ng/mL; p=0.009).Conclusions-Serum NGAL is a highly sensitive, but nonspecific predictor of AKI in critically ill children with septic shock. Further validation of serum NGAL as a biomarker of AKI in this population is warranted.

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“…[1][2][3][4] Adult and pediatric studies have shown that mortality increases with the number of organs involved. 2,4,5 Thus, multiple-organ dysfunction syndrome (dysfunction involving two or more organs) has been viewed as the inexorable pathway to death.…”

mentioning

confidence: 99%

Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children

Leteurtre

Duhamel²,

Grandbastien³

et al. 2010

Canadian Medical Association Journal

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Timing and predictors of death in pediatric patients with multiple organ system failure

Cited by 190 publications

References 0 publications

Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock

Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children

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