Abstract
IntroductionThe aim was to investigate the prevalence of endotoxemia in children admitted to pediatric intensive care unit (PICU), and its association with disease severity and outcome.MethodsWe conducted a prospective, observational cohort study of children admitted to PICU at St. Mary's Hospital, London over a 6-month period. One hundred consecutive patients were recruited. Demographic and clinical data were collected. Severity of illness was assessed by the pediatric index of mortality 2 (PIM2) score. The pediatric logistic organ dysfunction (PELOD) score was performed daily for the first 4 days. Patients were categorized according to primary reason for PICU admission. Blood samples were taken within 24 hours of admission and endotoxemia was measured using the endotoxin activity assay (EAA). Patients were stratified according to EAA level (high, EAA > 0.4, low, EAA < 0.4) and categorized as septic, post-surgical, respiratory or other. Data were analyzed using appropriate non-parametric tests.ResultsEAA level was significantly lower in PICU controls versus other PICU admissions (P = 0.01). Fifty-five children had endotoxemia on admission. Forty-one (75%) of these were eventually diagnosed with an infectious cause of admission. Nine children without infection had elevated EAA on admission. An infectious cause of admission was significantly associated with endotoxemia (P < 0.005). Of 15 children with gram-negative infection, only 9 (60%) had endotoxemia on admission. Endotoxemia on admission was not associated with shock or death. However, there was a tendency for increased PELOD score and length of stay in endotoxemic children.ConclusionsEndotoxemia is common in children admitted to intensive care. Understanding the implications of endotoxemia and potential anti-endotoxin strategies may have the potential to reduce severity of illness and length of PICU stay in critically ill children.
Highlights
The aim was to investigate the prevalence of endotoxemia in children admitted to pediatric intensive care unit (PICU), and its association with disease severity and outcome
The hypothesis that LPS contributes to disease severity in critical illness requires further exploration
Our study suggests that endotoxemia in critically ill children is common and can be detected with a simple bedside test
Summary
The aim was to investigate the prevalence of endotoxemia in children admitted to pediatric intensive care unit (PICU), and its association with disease severity and outcome. Sepsis is a major cause of admission to pediatric intensive care units (PICUs) and causes significant morbidity and mortality in children. A recent study from the US estimated that the incidence of pediatric severe sepsis is 0.56 cases per 1,000 population and that severe sepsis has an overall hospital mortality rate of 10.3% and accounts for 7% of all deaths in children [1]. The unadjusted case fatality rate for children admitted to PICUs in the UK is 4.1% and these children account for over 100,000 bed days. A recent audit of referrals of children with sepsis to PICUs in the UK found that 17% of these children died [3]
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