Статья

Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS)

Navin P. BoeddhaDepartment of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The NetherlandsLuregn J. SchlapbachDepartment of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, SwitzerlandGertjan J. DriessenDepartment of Paediatrics, Juliana Children's Hospital/Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA, The Hague, The NetherlandsJethro HerbergSection of Pediatrics, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ, UKIrene Rivero‐CalleGenetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706, Santiago de Compostela, SpainMiriam Cebey‐LópezGenetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706, Santiago de Compostela, SpainDaniela KlobassaDepartment of General Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, A-8036, Graz, AustriaRia PhilipsenRadboud Center for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The NetherlandsRonald de GrootSection of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The NetherlandsDavid InwaldImperial College LondonSimon NadelDepartment of Paediatrics, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, UKStéphane PaulusDivision of Paediatric Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, UKEleanor PinnockMicropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ, UKFatou SeckaMedical research Council Unit, Atlantic Boulevard, Fajara, P. O. Box 273, Banjul, The GambiaSuzanne T. AndersonMedical research Council Unit, Atlantic Boulevard, Fajara, P. O. Box 273, Banjul, The GambiaRachel AgbekoDepartment of Paediatric Intensive Care, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UKChristoph BergerDivision of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital Zurich, Steinwiesenstrasse 75, 8032, Zurich, SwitzerlandColin G. FinkMicropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ, UKEnitan D. CarrolInstitute of Infection & Global Health, University of Liverpool, 8 West Derby St, Liverpool, L7 3EA, UKWerner ZenzDepartment of General Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, A-8036, Graz, AustriaMichael LevinSection of Pediatrics, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ, UKMichiel van der FlierPediatric Infectious Diseases and Immunology Amalia Children's Hospital, and Radboudumc Expertise Center for Immunodeficiency and Autoinflammation (REIA), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The NetherlandsFederico Martinón‐TorresGenetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706, Santiago de Compostela, SpainJan A. HazelzetDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. [email protected]Marieke EmontsInstitute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK

2018en

ABI

Аннотация

BACKGROUND: Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability. METHODS: Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis. RESULTS: Patients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1-16.0, P = 0.04; disability OR 5.4, 95% CI 1.8-15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3-6.1, P < 0.01; disability OR 3.4, 95% CI 1.8-6.4, P < 0.001). CONCLUSIONS: Despite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.

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Идентификаторы

DOI: 10.1186/s13054-018-2052-7

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