Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study

Abstract

Background:Information regarding early predictive factors for mortality and morbidity in sepsis is limited from developing countries.Methods:A prospective observational study was conducted to determine the clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock. Children aged 1 month to 14 years admitted to a tertiary care pediatric intensive care unit (PICU) with a diagnosis of sepsis, severe sepsis, or septic shock were enrolled in the study. Hemodynamic and laboratory parameters which discriminate survivors from nonsurvivors were evaluated.Results:A total of 50 patients (30 [60%] males) were enrolled in the study, of whom 21 (42%) were discharged (survivors) and rest 29 (58%) expired (nonsurvivor). Median (interquartile range) age of enrolled patients were 18 (6, 60) months. Mortality was not significantly predicted individually by any factor including age (odds ratio [OR] [95% confidence interval [CI]]: 0.96 [0.91-1.01], P = 0.17), duration of PICU stay (OR [95% CI]: 1.18 [0.99-1.25], P = 0.054), time lag to PICU transfer (OR [95% CI]: 1.02 [0.93-1.12], P = 0.63), Pediatric Risk of Mortality (PRISM) score at admission (OR [95% CI]: 0.71 [0.47-1.04], P = 0.07) and number of organ dysfunction (OR [95% CI]: 0.03 [0.01-1.53], P = 0.08).Conclusion:Mortality among children with sepsis, severe sepsis, and septic shock were not predicted by any individual factors including the time lag to PICU transfer, duration of PICU stay, presence of multiorgan dysfunction, and PRISM score at admission.

Clinical profile and outcome of septic shock in children admitted to a tertiary care referral hospital

“…An Indian study from PGI, Chandigarh also reported high (65.8%) mortality rate in fluid refractory septic shock [15]. Other Indian studies have reported morality rates of 47% from Punjab, 50% from AIIMS, Delhi, 58% from Rohtak, Haryana [8,16,17]. Our findings are in line with other Indian studies.…”

“…Han YY et al reported that non-survivors were treated with more inotropic therapies as compared to survivors [18]. In a recent study from Rohtak where authors evaluated the hemodynamic and laboratory parameters which discriminated survivors from non survivors, it was found that mortality was not predicted by any individual factor like time lag to PICU transfer, duration of PICU stay, presence of MODS and PRISM score at admission [17]. However this study was limited by the small sample size.…”

Clinical profile of children mechanically ventilated in a pediatric intensive care unit of a limited resource setting

“…The duration of invasive ventilation was divided as <72 hours and >72 hours based on a study done in Haryana, which had 72 hours as the maximum duration of invasive ventilation. 3 We divided the cases as after spontaneous and planned extubation and also analysed the causes of reintubation. A complication was attributed to mechanical ventilation if it was not present before and it developed during ventilation.…”

Teaching the Principles of Pediatric Critical Care to Non-Intensivists in Resource Limited Settings: Challenges and Opportunities

“…In practical terms, however, “intensive care” can only be provided where these substantial resources and trained, multidisciplinary personnel are in place. The mere presence of an “intensive care unit” does not guarantee the presence of intensive, integrated care, or good outcomes, as the mortality rates in mixed and exclusively pediatric ICUs in LMICs can be as high as 50–58% ( 22 , 23 ). In any case, ICUs are uncommon in many parts of the world and, with rare exception, most of the world’s sickest children are cared for outside of conventional ICUs (pediatric or mixed) by caregivers without pediatric or critical care training.…”