Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock*

Abstract

Objectives: In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quality of life morbidity for children encountering community-acquired septic shock. Design: Prospective, cohort-outcome study, conducted 2013–2017. Setting: Twelve academic PICUs in the United States. Patients: Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support. Interventions: Demographic, infection, illness severity, organ dysfunction, and resource utilization data were collected daily during PICU admission. Serial parent proxy-report health-related quality of life assessments were obtained at baseline, 7 days, and 1, 3, 6, and 12 months following PICU admission utilizing the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale. Measurements and Main Results: Among 389 children enrolled, mean age was 7.4 ± 5.8 years; 46% were female; 18% were immunocompromised; and 51% demonstrated chronic comorbidities. Baseline Pediatric Overall Performance Category was normal in 38%. Median (Q1–Q3) Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores at PICU admission were 11.0 (6.0–17.0) and 9.0 (6.0–11.0); durations of vasoactive-inotropic and mechanical ventilation support were 3.0 days (2.0–6.0 d) and 8.0 days (5.0–14.0 d); and durations of PICU and hospital stay were 9.4 days (5.6–15.4 d) and 15.7 days (9.2–26.0 d). At 1, 3, 6, and 12 months following PICU admission for the septic shock event, 8%, 11%, 12%, and 13% of patients had died, while 50%, 37%, 30%, and 35% of surviving patients had not regained their baseline health-related quality of life. Conclusions: This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality of life morbidity among children encountering community-acquired septic shock. Although in-hospital mortality was 9%, 35% of survivors demonstrated significant, health-related quality of life deterioration from baseline that persisted at least 1 year following hospitalization for septic shock.

The Use of a Rapid Fluid Infusion System in Children

“…Also, a majority (61%) of our patients had a chronic disease, a risk factor for increased mortality from septic shock 44 . This frequency of chronic illness aligns with other reports finding rates of 40-70% of patients admitted to the PICU having a chronic illness 45,46 .…”

Implementation of a Follow-Up System for Pediatric Sepsis Survivors in a Large Academic Pediatric Intensive Care Unit

“…After implementation, we found that many patients in our program had new difficulties impacting their quality of life after sepsis, which is consistent with research studies reporting new morbidities and impacts on HRQL in children after sepsis (4)(5)(6)(7)(8)(9)(10)(11)20). Based on prior literature, we anticipated more difficulties in psychosocial domains rather than physical functioning (20); however, only one patient reported difficulties with attention, focus, and completion of school activities.…”

“…Over one-third of pediatric sepsis survivors have been reported to have new disability one to three months after sepsis diagnosis (4,6), with physical effects and behavioral impacts lasting years in meningococcal sepsis (9,10). In a multicenter, prospective study of health-related quality of life (HRQL) after communityacquired pediatric septic shock, over one-third of children surviving to hospital discharge had deterioration in HRQL on an in-depth assessment 1 year after hospital discharge (11). The largest decrease was seen in the first month after discharge with 50% of survivors below baseline HRQL, with some recovery that plateaued between 3 months and 1 year after discharge.…”

Updates on pediatric sepsis

“…In recent years, the relevance of long‐term outcomes beyond the hospitalization of children with sepsis received increasing attention. Of concern, more than one‐third of pediatric survivors had not regained their baseline health‐related quality of life one year after an episode of community‐acquired sepsis 95 . Lower quality‐of‐life scores were associated with multiorgan dysfunction, renal replacement therapy, ECMO or cardiopulmonary resuscitation, and duration of mechanical ventilation and inotropes 96 .…”