Prevalence and outcomes of sepsis in children admitted to public and private hospitals in Latin America: a multicenter observational study

Souza, Daniela Carla de; Barreira, Eliane Roseli; Shieh, Huei Hsin; Ventura, Andrea; Bousso, Albert; Troster, Eduardo Juan

doi:10.5935/0103-507x.20210030

Cited by 8 publications

(6 citation statements)

References 42 publications

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“…In this prospective, observational cohort of using pulse oximetry-derived PI in pediatric septic shock, we have three main findings: 1) at the time of admission with septic shock PI is low, 2) there is a weak inverse correlation between PI and serum lactate, and 3) use of critical PI impairment (≤ 0.6) at 6-hours as a "diagnostic test" of outcome needs further evaluation. Worldwide, pediatric sepsis is a major cause of morbidity and mortality (23,24). However, early recognition of septic shock and avoidance of harmful progressive hypoperfusion is challenging (25,26).…”

Section: Discussionmentioning

confidence: 99%

“…Worldwide, pediatric sepsis is a major cause of morbidity and mortality (23, 24). However, early recognition of septic shock and avoidance of harmful progressive hypoperfusion is challenging (25, 26).…”

Section: Discussionmentioning

confidence: 99%

“…VIS-1 30 (35-75) versus 16 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33); and VIS-3 20 (50-135) versus 0 (15-55) in the critical PI group. Likewise, we observed a difference in median (95% CI) ICU-free days (17 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] vs 25 [24][25][26]) and hospital-free days (7 [2-12] vs 22 [19][20][21][22][23][24][25]) in the critical PI group versus the other groups. Patients with a critical PI (≤ 0.6) at 6 hours, versus those not, had greater 30-day mortality (16/35 [46%] vs 9/77 [11%]; difference 31% [95% CI, 13.4-8.6%]).…”

Section: Perfusion Indexmentioning

confidence: 98%

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Perfusion Index Variations in Children With Septic Shock: Single-Center Observational Cohort Study in India

AV,

Kuzhikkombil Mani,

Ghosh

2023

Pediatric Critical Care Medicine

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OBJECTIVES: To study in children with septic shock: 1) variation in peripheral perfusion index (PI), which is a derived variable from pulse oximetry; 2) correlation between PI and lactate concentration; and 3) exploratory diagnostic evaluation between mortality and PI. DESIGN: Prospective observational study (from October 2018 to March 2020). SETTING: Pediatric emergency department and PICU of a tertiary hospital in India. PATIENTS: Children (1 mo to 16 yr old) with septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data collected included demographic, clinical, laboratory, and outcome-related variables. Hemodynamic variables like heart rate, mean arterial pressure, and PI, along with serum lactate were recorded at specified intervals. A total of 112 children with septic shock were recruited, with median (interquartile range [IQR]) age of 50 (IQR 12,118.5) months and 65 of 112 (58%) were male children. Overall mortality was 25 of 112 (22%). At admission, the median PI was 0.6 (IQR –0.30, 0.93), and we used PI less than or equal to 0.6 to define a “critical PI.” Of 61 children with critical PI at admission, 26 of 61 increased above this threshold by 6 hours. We observed a negative correlation between PI and lactate, at admission (r = –0.27; 95% CI, –0.44 to –0.08; p = 0.006) and at 6 hours (r = –0.21; 95% CI, –0.39 to –0.02; p = 0.03). In the exploratory analysis, a PI cutoff of less than or equal to 0.6 at 6 hours had area under the receiver operating curve of 0.74 (95% CI, 0.60–0.88). That is, with a 70% sensitivity and 81% specificity for mortality, the performance of such a test in our population (pre-to-post-test probability) for mortality would be 0.22–0.51. CONCLUSIONS: We have used pulse oximetry-derived PI in children presenting with septic shock and found that the value is negatively correlated with a rise in serum lactate concentration. However, the utility of using a critical threshold value in PI (≤ 0.6) after 6 hours of treatment to be indicative of later mortality has considerable uncertainty.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Perfusion Indexmentioning

confidence: 98%

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Perfusion Index Variations in Children With Septic Shock: Single-Center Observational Cohort Study in India

AV,

Kuzhikkombil Mani,

Ghosh

2023

Pediatric Critical Care Medicine

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“…De Souza et al conducted a post-hoc analysis of the Latin American Pediatric Sepsis Study (LAPSES) data and observed that the prevalence of septic shock within the first 24 h of pediatric ICU admission and sepsis-related mortality was significantly higher in public hospitals relative to private hospitals. The authors attributed this difference to greater disease severity and a larger proportion of patients with prior comorbidities and septic shock on admission in public hospitals ( 32 ). In our study, other factors also significantly contributed to death, such as chronic diseases, septic shock at hospital admission, and new organ dysfunction during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital

et al. 2021

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Introduction: Few studies in the literature discuss the benefits of compliance with sepsis bundles in hospitals in low- and middle-income countries, where resources are limited and mortality is high.Methods: This is a retrospective cohort study conducted at a public hospital in a low-income region in Brazil. We evaluated whether completion of a sepsis bundle is associated with reduced in-hospital mortality for sepsis, severe sepsis, and septic shock, as well as prevention of septic shock and organ dysfunction. Bundle compliance required the completion of three items: (1) obtaining blood count and culture, arterial or venous blood gases, and arterial or venous lactate levels; (2) antibiotic infusion within the first hour of diagnosis; and (3) infusion of 10–20 ml/kg saline solution within the first hour of diagnosis.Results: A total of 548 children with sepsis, severe sepsis, or septic shock who were treated at the emergency room from February 2008 to August of 2016 were included in the study. Of those, 371 patients were included in the protocol group and had a lower median length of stay (3 days vs. 11 days; p < 0.001), fewer organ dysfunctions during hospitalization (0 vs. 2, p < 0.001), and a lower probability of developing septic shock. According to a propensity score analysis, mortality was lower during the post-implementation period [2.75 vs. 15.4% (RR 95%IC 0.13 (0.06, 0.27); p < 0.001)].Conclusions: A simple and low-cost protocol was feasible and yielded good results at a general hospital in a low-income region in Brazil. Protocol use resulted in decreased mortality and progression of dysfunctions and was associated with a reduced probability of developing septic shock.

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“…The prevalence of sepsis was 42.6%, 25.9% had severe sepsis, and 19.8% went into septic shock. One of the risk factors of high mortality was the admission to a public hospital 16 …”

Section: Observationsmentioning

confidence: 99%

Sepsis in Children in Latin America

Arriola-Montenegro

Escalante-Kanashiro

2021

Pediatr Emer Care

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Prevalence and outcomes of sepsis in children admitted to public and private hospitals in Latin America: a multicenter observational study

Cited by 8 publications

References 42 publications

Perfusion Index Variations in Children With Septic Shock: Single-Center Observational Cohort Study in India

Perfusion Index Variations in Children With Septic Shock: Single-Center Observational Cohort Study in India

A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital

Sepsis in Children in Latin America

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