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Observational Study
. 2019 Oct;20(10):914-922.
doi: 10.1097/PCC.0000000000002044.

Outcomes of Day 1 Multiple Organ Dysfunction Syndrome in the PICU

Katri Typpo  1 , R Scott Watson  2   3 , Tellen D Bennett  4 , Reid W D Farris  2   3 , Michael C Spaeder  5 , Nancy J Petersen  6 ; Pediatric Existing Data Analysis (PEDAL) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Affiliations
Observational Study

Outcomes of Day 1 Multiple Organ Dysfunction Syndrome in the PICU

Katri Typpo et al. Pediatr Crit Care Med. 2019 Oct.

Abstract

Objectives: We sought to describe current outcomes of Multiple Organ Dysfunction Syndrome present on day 1 of PICU admission.

Design: Retrospective observational cohort study.

Setting: Virtual Pediatric Systems, LLC, database admissions, January 2014 and December 2015.

Patients: We analyzed 194,017 consecutive PICU admissions, (age 1 mo to 18 yr) from the 2014-2015 Virtual Pediatric Systems database.

Interventions: We identified day 1 Multiple Organ Dysfunction Syndrome by International Pediatric Sepsis Consensus Conference criteria with day 1 laboratory and vital sign values. Functional status was evaluated by Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores from PICU admission and discharge.

Measurements and main results: Overall, PICU mortality was 2.1%. We identified day 1 Multiple Organ Dysfunction Syndrome in 14.4% of admissions. Patients with Multiple Organ Dysfunction Syndrome had higher mortality than those without Multiple Organ Dysfunction Syndrome (10.3% vs 0.7%; p < 0.0001), and a higher percentage of survivors had greater than or equal to 2 category worsening in Pediatric Cerebral Performance Category score (3.6% vs 0.5%; p < 0.0001) or Pediatric Overall Performance Category score (6.0% vs 1.8%; p < 0.0001). The odds of death with day 1 Multiple Organ Dysfunction Syndrome was 14.3 (95% CI, 13-15.7), while the odds of death or discharge with Pediatric Overall Performance Category/Pediatric Cerebral Performance Category score greater than or equal to 3 (poor functional outcome) was 6.7 (95% CI, 6-7.4). In a subset of 148,188 patients from hospitals where limitation of support decisions were recorded, 5.8% patients with Multiple Organ Dysfunction Syndrome had limitation of support decisions in place, compared with 0.8% of patients without Multiple Organ Dysfunction Syndrome (p < 0.0001). Of day 1 Multiple Organ Dysfunction Syndrome patients who died, 43.1% had limitation of support decisions in place, and 41.6% had withdrawal of life-sustaining therapies (p < 0.0001).

Conclusions: Multiple Organ Dysfunction Syndrome present on day 1 of admission continues to be a major source of morbidity and mortality in the PICU, but risk of poor neurologic outcome may be improved. Further research is needed to understand decisions regarding limitation of support and withdrawal of life-sustaining therapy decisions in patients admitted with day 1 Multiple Organ Dysfunction Syndrome.

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Figures

Figure 1.
Figure 1.
Cohort Diagram, MODS Present on Day One of PICU Admission VPS LLC, Virtual Pediatric Systems, LLC; CPR, cardiopulmonary resuscitation; PICU, Pediatric Intensive Care Unit; MODS+, Multiple Organ Dysfunction Syndrome Present; MODS−, Multiple Organ Dysfunction Syndrome Absent.
Figure 2.
Figure 2.
Kaplan Meier Survival Analysis, 90 Day Observation Time MODS, Multiple Organ Dysfunction Syndrome; OD, Organ Dysfunction a. Survival curves for effect of Day One MODS on death. b. Survival curves for effect of number of dysfunctional organ systems present day one of PICU admission on death. Logrank p=<0.0001 for all graphs, stratified for patient age.
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