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Multicenter Study
. 2018 May 31;22(1):143.
doi: 10.1186/s13054-018-2052-7.

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 Boeddha  1   2 , Luregn J Schlapbach  3   4   5   6 , Gertjan J Driessen  2   7 , Jethro A Herberg  8 , Irene Rivero-Calle  9   10 , Miriam Cebey-López  10 , Daniela S Klobassa  11 , Ria Philipsen  12   13   14 , Ronald de Groot  13 , David P Inwald  15   16 , Simon Nadel  15   16 , Stéphane Paulus  17   18 , Eleanor Pinnock  19 , Fatou Secka  20 , Suzanne T Anderson  20 , Rachel S Agbeko  21   22 , Christoph Berger  23 , Colin G Fink  19 , Enitan D Carrol  18 , Werner Zenz  11 , Michael Levin  8 , Michiel van der Flier  12   13   24 , Federico Martinón-Torres  9   10 , Jan A Hazelzet  25 , Marieke Emonts  22   26   27 ; EUCLIDS consortium
Affiliations
Multicenter Study

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 Boeddha et al. Crit Care. .

Abstract

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.

Keywords: Bacteremia; Meningococcal infections; Morbidity; Mortality; Pneumococcal infections.

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Conflict of interest statement

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. The study protocol was approved by at least one ethical review board in every country (Coordinating center Research Ethics Committee reference: 11/LO/1982).

Consent for publication

Written informed consent was obtained from parents or legal guardians. In the Swiss study, consent was obtained if feasible, but collection of anonymized epidemiological data was approved for all patients. All authors have provided consent for publication of the manuscript.

Competing interests

The authors declare that they have no competing interests

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patients admitted with community-acquired sepsis to European pediatric intensive care units (PICUs). EUCLIDS, European Childhood Life-threatening Infectious Disease Study
Fig. 2
Fig. 2
Invasive pathogens in patients with community-acquired sepsis admitted to the pediatric intensive care unit. Invasive pathogens (n = 428) by age category. Numbers are higher as three patients had mixed bacterial infections (one patient with Staphylococcus aureus/gram-negative bacteria, two patients with gram-negative/gram-positive bacteria). The y-axis represents the percentage of respective pathogen within the age category, i.e. percentages of all pathogens within an age category add up to 100%. d, days; m, months
See this image and copyright information in PMC

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