Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China*

Abstract

Objectives: To estimate the prevalence, management, and outcomes of pediatric severe sepsis in the main PICUs in Southwest China. Design: A prospective, observational, and multicenter study. Setting: Eight PICUs in Southwest China with 19 (13–24) beds and 1,322 (1,066–1,452) annual admissions each. Patients: A total of 10,598 patients (29 d to 18 yr old) were consecutively admitted between September 1, 2016, and August 31, 2017. All patients were screened and evaluated for severe sepsis or septic shock. Of them, 10,353 patients were excluded due to incomplete data or not meeting the consensus criteria for severe sepsis or septic shock; 245 patients were included with complete data. Interventions: None. Measurements and Main Results: Finally, 245 patients who were diagnosed with severe sepsis or septic shock were included in the study, with an incidence rate of 2.3%. Of them, 64.0% of the enrolled patients were male with 80.8% being less than 5 years old and 60.8% being from rural areas. The respiratory system was the most common organ system in which dysfunction was observed (76.7%) as well as the most frequently infected site (37.6%). The primary therapies were antibiotics (99.0%), immunoglobulin (88.3%), mechanical ventilation (78.4%), vasoactive infusions (59.6%), and corticosteroids (46.1%). Among the 188 patients who had respiratory dysfunction, 173(92%) required mechanical ventilation and 39 (20.7%) met the criteria for pediatric acute respiratory distress syndrome. Seven of the patients with pediatric acute respiratory distress syndrome died (7/39, 17.9%). The median durations for mechanical ventilation and vasoactive medications were 123.5 hours (35.25–226.00 hr) and 2 days (1–5 d), respectively. Eighty-six percent of patients had multiple organ dysfunction syndrome at the point at which severe sepsis was recognized, and 31% had underlying conditions. The hospital mortality rate was 18.8%. Conclusions: This report is the first to present the prevalence, treatment, and outcomes of pediatric severe sepsis in the main PICU centers in Southwest China. The mortality rate remains high; therefore, improved clinical management and implementation of large-scale clinical trials are necessary to improve early diagnoses and treatment.

Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

“… 20 The incidence rate of sepsis-associated ALI in patients enrolled in this study during a 1-year period was 12.2% (10/82), which is consistent with our previous retrospective study on the sepsis-associated ALI incidence rate (9.7%, 72/745) 21 ; however, the incidence rate observed in the current study was lower than that of a recent study conducted in Southwest China (19.6%). 3 The PICU mortality of patients with sepsis-associated ALI was 40% in the present study, which is consistent with the observation of our previous retrospective study (36.1 [26/72]). 21 The mortality rate was significantly higher in patients with sepsis-associated ALI (40%, 4/10) than in patients without ALI (12.5%, 9/72) in our present study.…”

“… 2 In China, the hospital mortality of pediatric severe sepsis or septic shock is 18.8% or 80.8% of the cases comprise patients aged less than 5 years. 3 Pathologically, uncontrolled activation of the coagulation cascade is a fundamental event that leads to diffuse microvascular thrombosis, multi-organ dysfunction, and death. 3 – 6 The cross talk between thrombosis and inflammation supports the concept of a thrombo-inflammatory state correlates with septic severity and prognosis, 7 and thrombus biomarkers such as D-dimer, fibrinogen (Fib), and platelet count are associated with the short-term adverse outcomes of patients with sepsis.…”

“… 3 Pathologically, uncontrolled activation of the coagulation cascade is a fundamental event that leads to diffuse microvascular thrombosis, multi-organ dysfunction, and death. 3 – 6 The cross talk between thrombosis and inflammation supports the concept of a thrombo-inflammatory state correlates with septic severity and prognosis, 7 and thrombus biomarkers such as D-dimer, fibrinogen (Fib), and platelet count are associated with the short-term adverse outcomes of patients with sepsis. 7 – 9 However, it remains unclear whether specific indicators for thrombosis would be helpful in identifying patients with sepsis who are at an increased risk of death in the early onset of the condition, which is critical for risk identification and treatment decisions.…”

Sepsis in Children with Acute Lymphoblastic Leukemia

“…There was no significant difference in the sex and age distribution of the patients compared with those of other reports [18,20]. This finding was also reported by Sano et al [21].…”

“…This study reported the prevalence of sepsis in pediatric patients with ALL of 11.7% and 45.5% of deaths. In Southwest China, a multicenter prospective study of severe pediatric sepsis showed that the prevalence of sepsis in four provinces (Chongqing, Sichuan, Guizhou, and Yunnan) was higher than in Indonesia (17.9%, 16.2%, 22.4%, and 18.0%, respectively) [18]. An observational study in India about predictors of outcome and progression of pediatric sepsis reported that 13% progressed to severe sepsis, but in Philadelphia was 8.9% [1,19].…”