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Multicenter Study
. 2021 Aug 1;22(8):713-721.
doi: 10.1097/PCC.0000000000002680.

Pediatric Severe Sepsis and Shock in Three Asian Countries: A Retrospective Study of Outcomes in Nine PICUs

Rujipat Samransamruajkit  1 , Judith Ju-Ming Wong  2 , Chutima Smathakane  3 , Nattachai Anantasit  4 , Kanokkarn Sunkonkit  5 , Jacqueline Ong  6 , Olive Pei Ee Lee  7 , Pei-Chuen Lee  8 , Suwannee Phumeetham  9 , Rehena Sultana  2 , Usa Lapwanich  1 , Jan Hau Lee  2 , Lalida Kongkiattikul  1 ; Pediatric Sepsis Asian Collaboration (PEDSAC) Investigators and on behalf of the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN)
Affiliations
Multicenter Study

Pediatric Severe Sepsis and Shock in Three Asian Countries: A Retrospective Study of Outcomes in Nine PICUs

Rujipat Samransamruajkit et al. Pediatr Crit Care Med. .

Abstract

Objectives: Pediatric sepsis remains a major health problem and is a leading cause of death and long-term disability worldwide. This study aims to characterize epidemiologic, therapeutic, and outcome features of pediatric severe sepsis and septic shock in three Asian countries.

Design: A multicenter retrospective study with longitudinal clinical data over 1, 6, 24, 48, and 72 hours of PICU admission. The primary outcome was PICU mortality. Multivariable logistic regression analysis was used to identify factors at PICU admission that were associated with mortality.

Setting: Nine multidisciplinary PICUs in three Asian countries.

Patients: Children with severe sepsis or septic shock admitted to the PICU from January to December 2017.

Intervention: None.

Measurement and main results: A total of 271 children were included in this study. Median (interquartile range) age was 4.2 years (1.3-10.8 yr). Pneumonia (77/271 [28.4%]) was the most common source of infection. Majority of patients (243/271 [90%]) were resuscitated within the first hour, with fluid bolus (199/271 [73.4%]) or vasopressors (162/271 [59.8%]). Fluid resuscitation commonly took the form of normal saline (147/199 [74.2%]) (20 mL/kg [10-20 mL/kg] over 20 min [15-30 min]). The most common inotrope used was norepinephrine 81 of 162 (50.0%). Overall PICU mortality was 52 of 271 (19.2%). Improved hemodynamic variables (e.g., heart rate, blood pressure, and arterial lactate) were seen in survivors within 6 hours of admission as compared to nonsurvivors. In the multivariable model, admission severity score was associated with PICU mortality.

Conclusions: Mortality from pediatric severe sepsis and septic shock remains high in Asia. Consistent with current guidelines, most of the children admitted to these PICUs received fluid therapy and inotropic support as recommended.

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Conflict of interest statement

Dr. Samransamruajkit received funding from the Royal College of Pediatricians of Thailand. Dr. Smathakane disclosed government work. Dr. Phumeetham received funding from Siriraj research development fund. Dr. Jan Hau Lee received funding from KK Women’s and Children’s Hospital. The remaining authors have disclosed that they do not have any potential conflicts of interest

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