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Meta-Analysis
. 2019 Apr 1;173(4):352-362.
doi: 10.1001/jamapediatrics.2018.4839.

Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis

Bobby Tan  1 , Judith Ju-Ming Wong  2 , Rehena Sultana  1 , Janine Cynthia Jia Wen Koh  3 , Mark Jit  4 , Yee Hui Mok  2 , Jan Hau Lee  1   2
Affiliations
Meta-Analysis

Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis

Bobby Tan et al. JAMA Pediatr. .

Erratum in

  • Error in Figure.
    [No authors listed] [No authors listed] JAMA Pediatr. 2019 Apr 1;173(4):401. doi: 10.1001/jamapediatrics.2019.0488. JAMA Pediatr. 2019. PMID: 30933247 Free PMC article. No abstract available.

Abstract

Importance: The global patterns and distribution of case-fatality rates (CFRs) in pediatric severe sepsis and septic shock remain poorly described.

Objective: We performed a systematic review and meta-analysis of studies of children with severe sepsis and septic shock to elucidate the patterns of CFRs in developing and developed countries over time. We also described factors associated with CFRs.

Data sources: We searched PubMed, Web of Science, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central systematically for randomized clinical trials and prospective observational studies from earliest publication until January 2017, using the keywords "pediatric," "sepsis," "septic shock," and "mortality."

Study selection: Studies involving children with severe sepsis and septic shock that reported CFRs were included. Retrospective studies and studies including only neonates were excluded.

Data extraction and synthesis: We conducted our systematic review and meta-analysis in close accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled case-fatality estimates were obtained using random-effects meta-analysis. The associations of study period, study design, sepsis severity, age, and continents in which studies occurred were assessed with meta-regression.

Main outcomes and measures: Meta-analyses to provide pooled estimates of CFR of pediatric severe sepsis and septic shock over time.

Results: Ninety-four studies that included 7561 patients were included. Pooled CFRs were higher in developing countries (31.7% [95% CI, 27.3%-36.4%]) than in developed countries (19.3% [95% CI, 16.4%-22.7%]; P < .001). Meta-analysis of CFRs also showed significant heterogeneity across studies. Continents that include mainly developing countries reported higher CFRs (adjusted odds ratios: Africa, 7.89 [95% CI, 6.02-10.32]; P < .001; Asia, 3.81 [95% CI, 3.60-4.03]; P < .001; South America, 2.91 [95% CI, 2.71-3.12]; P < .001) than North America. Septic shock was associated with higher CFRs than severe sepsis (adjusted odds ratios, 1.47 [95% CI, 1.41-1.54]). Younger age was also a risk factor (adjusted odds ratio, 0.95 [95% CI, 0.94-0.96] per year of increase in age). Earlier study eras were associated with higher CFRs (adjusted odds ratios for 1991-2000, 1.24 [95% CI, 1.13-1.37]; P < .001) compared with 2011 to 2016. Time-trend analysis showed higher CFRs over time in developing countries than developed countries.

Conclusions and relevance: Despite the declining trend of pediatric severe sepsis and septic shock CFRs, the disparity between developing and developed countries persists. Further characterizations of vulnerable populations and collaborations between developed and developing countries are warranted to reduce the burden of pediatric sepsis globally.

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Figures

Figure 1.
Figure 1.. Flow Diagram for Included Studies
SIRs indicates systemic inflammatory response syndrome.
Figure 2.
Figure 2.. Cumulative Forest Plot of Case-Fatality Rates From All Included Studies
Forest plot is organized by year of data collection.
Figure 3.
Figure 3.. Pattern of Pooled Weighted Case-Fatality Rates From 1982 to 2016 for All Included Studies
See this image and copyright information in PMC

References

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