Severe Sepsis In Children Research Articles

A prospective cohort study of severe sepsis-induced dyslipidemia and changes in D-dimer levels in children: do they affect the prognosis?

BackgroundThe dyslipidemia and changes in D-dimer values that occur in children with severe sepsis remain unidentified.ObjectiveThe current research aimed to explore the relationship between D-dimer and lipid profile values, including total cholesterol (TC), lipoproteins, apolipoprotein A-V (Apo A-5), triglycerides (TG), and in-hospital nonsurvival in children with severe sepsis or septic shock in pediatric intensive care.Study designThe study design is as follows: prospective cohort study.ParticipantsChildren with severe sepsis or septic shock who were admitted to the intensive care unit of a university pediatric hospital.InterventionVital signs, sepsis assessment, pediatric sequential organ failure assessment (PSOFA) score, high-density lipoprotein (HDL), Apo A-5, TG, low-density lipoprotein (LDL), TC, D-dimer, mortality outcome, and pediatric risk of mortality (PRISM) III score were evaluated.OutcomesThe primary outcome was in-hospital nonsurvival.ResultsThe nonsurvivors had significantly higher D-dimer levels than the survivors, with a significant cutoff level of 0.87 μg/mL (AUC: 0.85, sensitivity: 93.3%, PVN: 90.6%, accuracy: 79.0%, PVP: 72.5%, and specificity: 64.7%). D-dimer was inversely correlated with WBC count and positively correlated with patient age, PRISM III score, PSOFA score, and INR. However, nonsurvivors had higher TG levels and lower TC, HDL, LDL, and Apo A-5 levels than survivors, but this variation was insignificant. Apo A-5 levels were inversely correlated with HDL and positively correlated with TG levels.ConclusionsThis study suggests that D-dimer is a promising biomarker for severe sepsis in children, with a mortality cutoff level of 0.87 μg/mL. However, lipid profiles are not predictors of sepsis-related mortality.

Retracted: Clinical Characteristics and Death Risk Factors of Severe Sepsis in Children.

[This retracts the article DOI: 10.1155/2022/4200605.].

Does MALAT1 (NEAT2) Predict the Prognosis of Sepsis in Pediatric Patients?

Background: Sepsis is one of the major causes of disability and death in the pediatric population globally. Although metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been reported to be associated with the survival of adult patients with sepsis, its prognostic value in children has not been identified. Objectives: The present study aimed to evaluate the role of MALAT1 in the prognosis of severe sepsis in children. Methods: A total of 60 children with severe sepsis were included in this research. Serum level of MALAT1 was assessed at baseline, and the survival data were recorded during a follow-up of 28 days. These participants were categorized into high or low MALAT1 groups based on the median value. Multivariate Cox regression was performed to explore the association of MALAT1 level with the survival of pediatric patients with sepsis after controlling for potential confounding factors. Results: The 28-day mortality rate of severe sepsis was 35%. The expression of MALAT1 in the non-survivors was significantly higher than in the survived patients (P < 0.01). The multivariate Cox proportional hazards model, showed that a higher MALAT1 expression was associated with a higher risk of mortality in patients with severe sepsis (HR = 6.70; 95% CI: 1.65 - 27.2; P < 0.01). Conclusions: According to our results, MALAT1 might be a promising marker for predicting the prognosis of severe pediatric sepsis.

Clinical Characteristics and Death Risk Factors of Severe Sepsis in Children.

Sepsis is a systemic inflammatory response syndrome caused by viral infection. The circulatory dysfunction caused by sepsis is also called septic shock or septic shock. The main characteristics are rapid onset, rapid changes, and involvement. Multiple organs in the body make diagnosis difficult, which seriously threatens the survival of patients. As many as one million people worldwide die every year because of SIRS, it is also the leading cause of death among children in hospital ICUs. This article is aimed at studying the clinical characteristics of severe sepsis in children and the risk factors for death. Based on the analysis of the pathogenesis of sepsis and the treatment of septic shock, 65 cases of children with PICU sepsis admitted to a hospital were selected. Data, to study its clinical characteristics and risk factors for death. The results of the study showed that despite the interaction among the removal factors of the three indexes of serum lactic acid value, PCIS level, and the number of organs involved in MODS, they are still related to the mortality of children with severe sepsis.

Utility of specific laboratory biomarkers to predict severe sepsis in pediatric patients with SIRS.

To identify the association between readily available laboratory biomarkers and the development of severe sepsis in children presenting to the emergency department (ED) with systemic inflammatory response syndrome (SIRS). In this retrospective cohort study, ED patient encounters from June 2018 to June 2019 that triggered an automated sepsis alert based on SIRS criteria were analyzed. Encounters were included if the patient had any of the following laboratory tests sent within 6h of ED arrival: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactic acid, and procalcitonin. For each of the biomarkers, a receiver operating characteristic (ROC) curve was created for our primary outcome, severe sepsis within 24h of ED disposition, and our secondary outcome, severe sepsis with a positive bacterial culture. For each ROC curve, we calculated the area under the curve (AUC) with 95% confidence intervals (95% CI) and created cutoff points to achieve 90% sensitivity and 90% sensitivity for the primary and secondary outcomes. During the study period, 4349/61,195 (7.1%) encounters triggered an automated sepsis alert. Of those, 1207/4349 (27.8%) had one of the candidate biomarkers sent within 6h of ED arrival and were included in the study. A total of 100/1207 (8.3%) met criteria for severe sepsis within 24h of arrival, and 41/100 severe sepsis cases (41%) were deemed culture-positive. Procalcitonin had the highest AUC for identifying severe sepsis [0.62 (95% CI 0.52-0.73)] while ESR and CRP had the highest AUC for culture-positive sepsis [0.68 (95% CI 0.47-0.89) and 0.67 (95% CI 0.53-0.81), respectively]. At 90% sensitivity for detecting severe sepsis, all of the biomarker threshold values fell within that laboratory test's normal range. At 90% specificity for severe sepsis, threshold values were as follows: procalcitonin 2.72ng/mL, CRP 16.79mg/dL, ESR 79.5mm/h and lactic acid 3.6mmol/L. Our data indicate that CRP, ESR, lactic acid, and procalcitonin elevations were all specific, but not sensitive, in identifying children in the ED with SIRS who go on to develop severe sepsis.

Research Progress of Continuous Blood Purification in the Treatment of Severe Sepsis in Children

Pediatric sepsis is the most common disease in pediatric critical illness, because the main reason for the disease is that children's immune level is not high or the immune system is not perfect, when children's lung, abdominal cavity and blood system are infected, it will cause systemic inflammation and immune dysfunction. Early clinical symptoms are mainly irregular and intermittent fever. When the disease develops to severe sepsis, the children will suffer from acute heart failure, oliguria, respiratory alkalosis and even multiple organ failure. The incidence of death is high. It is reported that the incidence rate of sepsis in children can reach 0.3%, and the mortality rate is 50%. High incidence rate, high mortality rate and high treatment cost are the biggest problems in the pediatric field. In the past, the clinical hope of clearing away heat and toxin, promoting blood circulation and removing stasis, strengthening inflammation and other methods in traditional Chinese medicine, but the treatment effect is not ideal. With the improvement of modern medical understanding of sepsis, continuous blood purification therapy is introduced into the treatment of children with severe sepsis. In order to further explore the effect of continuous blood purification in the treatment of children with severe sepsis, the author summarizes the clinical practice experience and relevant literature, hoping to provide reference for relevant medical staff.

Neutrophil-to-lymphocyte ratio as a predictive marker for severe pediatric sepsis.

BackgroundAlthough neutrophil-to-lymphocyte ratio (NLR) has been extensively studied in several diseases, its role in pediatric sepsis remains unclear. Our study aimed to assess the predictive significance of NLR for severe pediatric sepsis in the pediatric intensive care unit (PICU).MethodsWe retrospectively recruited critically ill children in the PICU with severe pediatric sepsis from January 2019 to January 2020 in West China Hospital of Sichuan University. Univariate and multivariable logistic regression analysis was used to assess the risk factors of severe pediatric sepsis. Receiver operating characteristic (ROC) curves were plotted for the comparison of the prediction significance of NLR.ResultsOverall, 202 patients (severe sepsis 45; non-severe sepsis 157) were included. In the severe sepsis group, the levels of NLR (P<0.001), procalcitonin (PCT; P<0.001), and the Pediatric Risk of Mortality score (PRISM III) were higher than those in the nonsevere sepsis group (P<0.001). The PICU stay time (P<0.001), mechanical ventilation length (P=0.004), and hospital stay time (P<0.001) in the severe sepsis patients were noticeably more extended than those in the control patients. The area under the ROC curve (AUC) of NLR was 0.715 (P<0.001), which was higher than that of the PRISM III score (AUC =0.651, P<0.001) and PCT (AUC =0.647, P<0.001). Furthermore, the constructed predictive model of NLR + PCT + PRISM III showed a better prediction significance than they alone (AUC =0.888, P<0.001).ConclusionsResults indicated that the initial NLR value was a significant biomarker for predicting severe pediatric sepsis. The combined NLR and PCT improved the evaluation for further early identification of severe sepsis in children.

Early diagnosis of severe sepsis in children in the first year of life.

Early diagnosis of severe sepsis in children in the first year of life.

Increased Risk of Severe Sepsis in Hispanic Children Hospitalized With Acute Myeloid Leukemia

The purpose of this study, a secondary analysis of a publicly available database, was to identify racial and ethnic disparities in the risk of severe sepsis facing children undergoing the intensive therapy necessary to treat acute myeloid leukemia (AML). The sample consisted of 1,913 hospitalizations of children, younger than 21 years, in the United States during the year 2016 with documentation of both AML and at least one infectious complication. Binary logistic regression models were used to examine the association between race/ethnicity and severe sepsis in children with AML and infection. We found that, after controlling for potential confounding variables, the odds of developing severe sepsis were significantly increased for Hispanic children compared with White children. There were no significant differences in the likelihood of the development of sepsis in Black, Asian, or other race children. The increased risk of severe sepsis for Hispanic children may contribute to the disparate rates of overall survival in this group. This inequitable rate of severe sepsis was evident despite the generally accepted practice of retaining children in the hospital throughout recovery of blood counts following AML therapy. Nurses are in a position to identify and eliminate modifiable risk factors contributing to this disparity.

Prognosis and rehabilitation of sepsis-associated encephalopathy

Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which can greatly increase the mortality of patients with sepsis, and may result in prolonged cognitive dysfunction in SAE survivors.Therefore SAE has received more and more attention in the field of critical illness.However, there are few studies on the mechanism of poor prognosis and possible predictors of SAE, and no specific rehabilitation methods have been reported.In this article, progress in the research on the prognosis and rehabilitation of SAE is summarized, in order to provide a reference for the long-term prognosis and rehabilitation treatment of severe sepsis in children. Key words: Sepsis-associated encephalopathy; Prognosis; Rehabilitation

Prediction of the Development of Severe Sepsis Among Children With Intestinal Failure and Fever Presenting to the Emergency Department.

Children with intestinal failure (IF) and fever are frequently bacteremic, but risk factors for development of sepsis in this population are not well delineated. Our objective was to determine what clinical factors available on arrival to the emergency department (ED), including commonly used vital sign thresholds, predicted the subsequent development of severe sepsis in children with IF and fever. This was a retrospective cohort study of children younger than 21 years with IF presenting to a tertiary care ED between 2010 and 2016 with fever who did not have hypotensive septic shock on arrival. The primary outcome was development of severe sepsis within 24 hours of ED arrival, as defined by consensus criteria. We identified predictors of severe sepsis using both univariate and multivariate models and calculated the test characteristics of 3 different sets of vital sign criteria in determining risk of severe sepsis. In 26 (9.4%) of 278 encounters, the patient developed severe sepsis within 24 hours of arrival to the ED; 3 were excluded due to hypotensive shock on arrival. Predictors of severe sepsis included history of intestinal pseudo-obstruction (odds ratio, 8.2; 95% confidence interval, 2.3-30.2) and higher initial temperature (odds ratio, 1.7; 95% confidence interval, 1.2-2.3). The 3 sets of vital sign criteria had widely varying sensitivity and specificity in identifying development of severe sepsis. History of intestinal pseudo-obstruction and higher fever predicted increased risk of severe sepsis among children with IF and fever presenting to an ED. No single set of vital sign criteria had both high sensitivity and specificity for this diagnosis.

Hispanic Race Is Associated with Increased Risk of Severe Sepsis in 1913 Hospitalizations of Children with AML and Infection

Hispanic Race Is Associated with Increased Risk of Severe Sepsis in 1913 Hospitalizations of Children with AML and Infection

Clinical analysis of continuous blood purification in the treatment of severe sepsis in infants

Objective To investigate the clinical efficacy and safety of continuous blood purification (CBP) in the treatment of severe sepsis in infants. Methods A retrospective analysis of 40 infants with severe sepsis treated with CBP was performed at PICU of Hunan Children′s Hospital from January 2014 to July 2017, and 50 infants with severe sepsis who were not treated with CBP at the same period were enrolled as control group.The indicators included blood gas analysis, lactic acid (Lac), blood glucose, electrolytes, blood routine, C-reaction protein (CRP) and procalcitonin (PCT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST), total bilirubin(TB), urea nitrogen (BUN), serum creatinine (Scr) and creatine kinase isoenzyme MB (CK-MB), pediatric critical illness score (PCIS). Results (1) After 3 days of treatment, the recovery of body temperature, heart rate, respiratory rate and blood pressure in CBP group were better than those in the control group, and the differences between two groups were statistically significant(P 0.05). (5) Two cases of thrombocytopenia, 2 cases of femoral vein thrombosis, 2 cases of hypovolemic shock, and 1 case of blood coagulation in filter happened in CBP gruop, all cases had no puncture site infection. Conclusion CBP can improve the vital signs, internal environment, inflammatory reaction and organ function of infants with severe sepsis, and the effect is better than that of traditional methods.The complications of CBP in infants with severe sepsis are relatively large, so we should strictly master the indications of CBP in the treatment of severe sepsis in children. Key words: Continuous blood purification; Severe sepsis; Infants; Clinical efficacy; Safety

38) Early detection of clinically relevant sepsis in children

Background: Early identification of severe sepsis in children in order to administer goal-directed therapy remains a challenge. We have initiated a real-time EMR-integrated screening algorithm, called e-ASSIST, for children ages 6-12 at risk for clinically relevant sepsis. MicroRNAs (miRNAs) are a newer class of potential biomarkers …

Use of plasma exchange in pediatric severe sepsis in children's hospitals

Pediatric severe sepsis (PSS) is an important cause of death in children. Mortality increases in those with sepsis and multiple organ dysfunction syndrome (MODS). Plasma exchange (PE) has been used as an adjuvant therapy in sepsis, with trials demonstrating variable success. This observational retrospective cohort study aimed to characterize patient demographics, PE use, mortality and resource utilization in septic children from 43 children’s hospitals from 2004 to 2012. Of 49,153 PSS cases, 1.8% utilized PE. Utilization increased to 4.8% in those with sepsis and MODS. Comorbidities affected 72-74% of patients. PE patients noted a longer hospitalization than PSS patients (39 vs 17 days). Overall mortality was 14.1% in PSS, increasing to 32.1% in PSS patients receiving PE. Mortality was 22% and 44.4% in PE patients without and with MODS respectively. Mortality decreased over the study period in both PE subgroups. In conclusion, PE utilization in PSS remained stable throughout the study period while PSS mortality decreased over time. Children utilizing PE had a higher associated mortality, but also greater comorbidities and MODS prevalence, likely representing a predilection towards use in more critically ill patients. These data can provide demographic and outcome results to inform future PE trials in sepsis.

Confirmation of Host Genetic Determinants in the CFH Region and Susceptibility to Meningococcal Disease in a Central European Study Sample.

Invasive meningococcal disease (IMD) is a leading cause of meningitis and severe sepsis in children and adolescents. Genetic factors are important in determining the susceptibility to and outcome of IMD. Recently, a genome-wide association study from the United Kingdom showed significant associations of single-nucleotide polymorphisms within complement factor H (CFH; rs1065489) and in CFH-related protein 3 (rs426736) with susceptibility of IMD. We report data of a genetic replication study in Central European children. The study was conducted as a retrospective case-reference study involving 248 patients with confirmed diagnosis of IMD from Austria and Germany and 835 healthy reference individuals from a multicenter German birth cohort. Carriers of the minor alleles of rs1065489 and rs426736 were at lower risk of IMD [allelic odds ratio = 0.60 (0.44-0.82); P = 0.001 and 0.61 (0.45-0.83); P = 0.001]. Also, 2 major haplotypes (GT and TC) derived from the 2 single-nucleotide polymorphisms were significantly associated with IMD (P = 0.001 and P = 0.003, respectively). The consistency of the results between the genome-wide association study and our study population strengthens the association of CFH polymorphisms to the susceptibility of IMD. Our results support the conclusion that CFH is a critical determinant in acquiring meningococcal disease.

Respiratory support strategy of severe sepsis in children

The definition of severe sepsis has been renewed in 2012 international guidelines for management of severe sepsis and septic shock.This article summarizes briefly respiratory support strategy of severe sepsis which incorporated with new guideline and recent progress in sepsis and mechanical ventilation (MV). Oxygen therapy, indication of mechanical ventilation, the support roles of MV on septic shock, drug selection, MV strategy and hemodynamic monitoring are included in this article. Key words: Sepsis; Respiratory support; Mechanical ventilation; Child

Escherichia coli bacteremia in children: age and portal of entry are the main predictors of severity.

Escherichia coli bacteremia is a major cause of severe sepsis in children. Little is known about predictors of severity. We analyzed 84 children ≤ 18 years of age with E. coli bacteremia from the prospective COLIBAFI study performed during 2005-2007. The severity of bacteremia was defined as occurrence of death or transfer to intensive care unit. Studied characteristics included age, gender, birth weight, history of prematurity, immunodepression, nosocomial infection, portal of entry, phylogenetic group and subgroup belonging, O-type, virulence gene content and antimicrobial susceptibility. We compared bacterial characteristics in urinary- versus digestive-source bacteremia, in children ≤ 3 versus >3 month of age, and in children versus adults. We also searched for risk factors of severity. Median age was 2.4 months, 57% males. Most frequent portals of entry were urinary (66.2%) and digestive (19.5%) tracts. Most isolates (63.1%) belonged to B2 phylogroup. Strains in children ≤ 3 months of age exhibited more virulence genes, especially neuC and fyuA/irp2, and were less resistant to antibiotics than in children >3 months of age. Comparing community-acquired urinary-source bacteremia between children and adults, we found that bacteremia were less severe in children, whose strains exhibited a specific virulence gene repertoire and had a higher resistance score than in adults. Seventeen children (20.2%) had a severe bacteremia and 8 died. Non-urinary portal of entry and age ≤ 3 months of age were the only risk factors associated with severity. E. coli strains responsible for bacteremia exhibit specific characteristics according to age of children. However, host characteristics and portal of entry are the main determinants of severity of E. coli bacteremia in children, as observed in adults.

Prospective Validation of a Risk Prediction Model for Severe Sepsis in Children With Cancer and High-risk Febrile Neutropenia

We previously created a risk prediction model for severe sepsis not clinically apparent during the first 24 hours of hospitalization in children with high-risk febrile neutropenia (HRFN), which identified 3 variables, age ≥ 12 years, serum C-reactive protein (CRP) ≥ 90 mg/L and interleukin-8 ≥ 300 pg/mL, evaluated at the time of admission and at 24 hours of hospitalization. The combination of these 3 variables identified a risk for severe sepsis ranging from 8% to 73% with a relative risk of 3.15 (95% confidence interval: 1.1-9.06). The aim of this study was to validate prospectively our risk prediction model for severe sepsis in a new cohort of children with cancer and HRFN. Predictors of severe sepsis identified in our previous model (age, CRP and interleukin-8) were evaluated at admission and at 24 hours of hospitalization in a new cohort of children with HRFN between April 2009 and July 2011. Diagnosis of severe sepsis, not clinically apparent during the first 24 hours of hospitalization, was made after discharge by a blind evaluator. A total of 447 HRFN episodes were studied, of which 76 (17%) had a diagnosis of severe sepsis. The combination of age ≥ 12 years, CRP ≥ 90 mg/L and interleukin-8 ≥ 300 pg/mL at admission and/or at 24 hours in the new cohort identified a risk for severe sepsis ranging from 7% to 46% with an RR of 6.7 (95% CI: 2.3-19.5). We validated a risk prediction model for severe sepsis applicable to children with HRFN episodes within the first 24 hours of admission. We propose to incorporate this model in the initial patient assessment to offer a more selective management for children at risk for severe sepsis.

Trends in the Epidemiology of Pediatric Severe Sepsis*

In the past decade, guidelines have been developed for the early detection and management of severe sepsis in children and neonates. However, severe sepsis continues to be a significant U.S. healthcare problem, accounting for over 720,000 annual hospitalizations. Large-scale epidemiologic studies of severe sepsis continue to be limited, particularly in children. We present data from 1995, 2000, and 2005 in seven U.S. states, examining how case mix, outcome, and resource use for pediatric severe sepsis have changed over time. We constructed a database including all acute-care hospitalizations for children in the seven states. For each case, we extracted data on demographic characteristics; the principal diagnosis, up to six secondary diagnoses, and six procedures as classified by the International Classification of Diseases, 9th Revision, Clinical Modification codes; and in-hospital fatality. We identified patients with severe sepsis using International Classification of Diseases, 9th Revision, Clinical Modification codes for both infection and acute organ failure. Retrospective observational cohort dataset from seven U.S. states from 1995, 2000, and 2005. Children in the U.S. 0-19 years old. None. In 2005, 17,542 children were hospitalized with severe sepsis in the seven states; there was an 81% increase in pediatric severe sepsis cases since 1995 and a 45% increase since 2000. This corresponded to an increase in prevalence from 0.56 to 0.89 cases per 1,000 pediatric population. Between 1995 and 2005, the prevalence of severe sepsis in newborns more than doubled, from 4.5 to 9.7 cases per 1,000 births. The most common infecting organisms in all 3 years were Staphylococcus species. From 1995 to 2005, the case-fatality rate decreased from 10.3% to 8.9%. Case fatality associated with Staphylococcus aureus increased, whereas fatality associated with Streptococcus pneumoniae decreased by 75%. Nationally, there were 75,255 pediatric hospitalizations in 2005 involving severe sepsis, with an associated cost of $4.8 billion. Between 1995 and 2005, the prevalence of severe sepsis in U.S. children steadily rose, due to a significant increase in the prevalence of severe sepsis in newborns.