Clinical outcomes after utilizing surviving sepsis campaign in children with septic shock and prognostic value of initial plasma NT-proBNP

Abstract

Background and objective: The surviving sepsis campaign treatment guideline (SSC) implementation is associated with improved outcome in adults with severe sepsis. The effect on outcome of pediatric sepsis is less clear.

Purpose: To determine the clinical outcomes of SSC implementation and to investigate the prognostic value of initial plasma NT-proBNP and procalcitonin in children.

Materials and methods: Infants and children (aged 1month/0-15 years with severe sepsis or septic shock) were prospectively enrolled and treated according to the guidelines. Initial blood drawn was saved for NT-pro-BNP, procalcitonin measurements and clinical data were also recorded.

Results: A total of 47 subjects were recruited. Since the application of the SSC, our mortality rate had significantly decreased from 42-19% (P = 0.003) as compared to the data in the previous 3 years. Clinical factors that significantly increased the mortality rate were: Initial central venous oxygen saturation < 7 0% after fluid resuscitation [odds ratio (OR) = 23.3; 95% confidence interval (CI) 3.7-143; P = 0.001], and initial albumin level (≤ 3 g/dl, OR = 6.7; 95% CI 1.2-37.5, P = 0.03). There was asignificant difference between the initial NT-proBNP levels between survivors and non survivors, (6280.3 ± 9597 ng/L, P < 0.001), but not for procalcitonin (12.7 ± 24.8, 29.3 ± 46 μg/L, P = 0.1), respectively. An initial NT-proBNP level of more than 11,200 pg/ml predicted Pediatric Intensive Care Unit (PICU) mortality with a sensitivity of 85.7% and a specificity of 90%.

Conclusions: A modified SSC for severe sepsis and septic shock significantly reduced the mortality rate in our PICU. High initial NT-ProBNP level was associated with mortality.

Keywords: Biomarker; SSC guideline; decrease mortality; mortality; pediatric sepsis; severe sepsis; surviving sepsis campaign.

Figure 1

Demonstrates the difference of sepsis mortality compared between the group that achieved central venous oxygen saturation target goal >70% after initial fluids resuscitation and the group that had ScvO₂ < 70% after fluids resuscitation (*P < 0.01)

Figure 2

Demonstrates the total amount of volume resuscitation (cc/ kg) in children with septic shock compared between survivors and non survivors at 1 and 6 h after fluid resuscitation (*P < 0.04)

Figure 3

Demonstrates the levels of initial pBNP was significantly higher in non survivors compared with survivors (P < 0.01)

Figure 4

Demonstrates receiver-operator characteristic curves for predictive of mortality in children with septic shock compared between initial NT-proBNP (levels > 11,200 ng/L, sensitivity 85%, specificity 93%) and initial procalcitonin (levels > 1.42 ƒÝ/L, sensitivity 85%, specificity 49%)