Frequency of organ dysfunction and impact on mortality in children with blood culture-proven sepsis - Results from the Swiss Pediatric Sepsis Study

Abstract

Background and aims: Recently, the definition of sepsis in adults has been refined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Objectives: We analysed the relationship of number of organ dysfunctions with case fatality rate in a prospectively collected dataset on sepsis in children. Methods: Prospective observational cohort study of newborns and children <17 years with blood culture-proven sepsis admitted to ten paediatric hospitals in Switzerland between 9/2011 and 12/2015. Sepsis and organ dysfunctions were defined according to the 2005 pediatric consensus definition. Results: Of 1204 blood culture-proven sepsis episodes, organ dysfunction was present in 474 (39%). In 590 (49%) episodes patients were admitted to the intensive care unit, and in 323 (55%) of those episodes patients required mechanical ventilatory support. In 90 of 1204 (7.5%) episodes the outcome was fatal in the first 30 days after sepsis onset. The odds ratio of death increased by 2.9 (95%CI 2.5-3.5, p <0.001) for every additional organ dysfunction; from a case fatality rate of 0.7% (95%CI 0.3-1.7) in 730 episodes with no organ dysfunction to 46% (95%CI 34.4-58.7) in 69 episodes with 4 or more organ dysfunctions. Conclusion: Only a minority of children presenting with blood culture-proven sepsis as per 2005 pediatric consensus definition had an organ dysfunction. Presence and number of organ dysfunctions were strongly associated with mortality, and should be considered for future sepsis definitions to discriminate children with infection from children with life-threatening dysregulated host response to infection.L6270229382019-04-05 <br />