Abstract
BackgroundSepsis is the leading cause of death worldwide in pediatric populations. Studies in low-resource settings showed that the majority of pediatric patients with sepsis still have a high mortality rate.MethodsWe retrospectively collected records from 2014 to 2019 of patients who had been diagnosed with sepsis and admitted to PICU in our tertiary hospital. Cox proportional hazard regression modeling was used to evaluate associations between patient characteristics and mortality.ResultsOverall, 665 patients were enrolled in this study, with 364 (54.7%) boys and 301 (46.3%) girls. As many as 385 patients (57.9%) died during the study period. The median age of patients admitted to PICU were 1.8 years old with interquartile range (IQR) ±8.36 years and the median length of stay was 144 h (1–1896 h). More than half 391 patients (58.8%) had a good nutritional status. Higher risk of mortality in PICU was associated fluid overload percentage of > 10% (HR 9.6, 95% CI: 7.4–12.6), the need of mechanical ventilation support (HR 2.7, 95% CI: 1.6–4.6), vasoactive drugs (HR 1.5, 95% CI: 1.2–2.0) and the presence of congenital anomaly (HR 1.4, 95% CI: 1.0–1.9). On the contrary, cerebral palsy (HR 0.3, 95% CI: 0.1–0.5) and post-operative patients (HR 0.4, 95% CI: 0.3–0.6) had lower mortality.ConclusionPICU mortality in pediatric patients with sepsis is associated with fluid overload percentage of > 10%, the need for mechanical ventilation support, the need of vasoactive drugs, and the presence of congenital anomaly. In septic patients in PICU, those with cerebral palsy and admitted for post-operative care had better survival.
Highlights
Sepsis is the leading cause of death worldwide in pediatric populations
A study in a low-resource setting showed that 58% of pediatric patients with sepsis died, 58% had inotropic support, 18% had bloodstream infection, and 58% were supported with mechanical ventilation [4]
We found that the presence of chronic disease comorbidities, the need of invasive mechanical ventilation support and vasoactive drugs, septic shock, post-operative patient and fluid overload percentage > 10% to be significantly different between those that died and those that survived
Summary
Sepsis is the leading cause of death worldwide in pediatric populations. Studies in low-resource settings showed that the majority of pediatric patients with sepsis still have a high mortality rate. A study in a low-resource setting showed that 58% of pediatric patients with sepsis died, 58% had inotropic support, 18% had bloodstream infection, and 58% were supported with mechanical ventilation [4]. The high number of fatalities in low-resource settings caused by sepsis and its severity led us to study patient characteristics that were associated with mortality due to sepsis. Many previous studies in low-resource settings only provided the number of pediatric mortality but did not look for the factors that caused it [8]. This study aimed to evaluate the outcome of patients with sepsis admitted to PICU and its associated factors in a low-resource setting
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