Portal de Periódicos da CAPES

Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

Elsevier BV; Volume: 242; Linguagem: Inglês

10.1016/j.jss.2019.04.011

1095-8673

Rajan K. Thakkar, Scott L. Weiss, Julie C. Fitzgerald, Luke Keele, Neal J. Thomas, Vinay Nadkarni, Jennifer A. Muszynski, Mark W. Hall, Patrícia S. Fontela, Mauro R. Tucci, M. Dumistrascu, Peter Skippen, Gordon Krahn, E. Bezares, Gilberto Puig, A. Puig-Ramos, Richard U. Garcia, M. Villar, Michael T. Bigham, T. Polanski, Seied Amirhossein Latifi, D. Giebner, Heather Anthony, Janet R. Hume, A. Galster, L. Linnerud, Ronald C. Sanders, Glenda Hefley, Kate Madden, Anne Thompson, Steven L. Shein, Shira J. Gertz, Ying Han, Tatjana Williams, A. Hughes-Schalk, Heather K. Chandler, Alberto Orioles, Erin E. Zielinski, Abigail Doucette, Alberto Orioles, Erin E. Zielinski, Abigail Doucette, Carleen Zebuhr, Tremika LeShan Wilson, Constantine Dimitriades, J. Ascani, S. Layburn, S. Valley, B. Markowitz, James G. Terry, Rica Morzov, Alistair McInnes, Jennifer McArthur, Katherine Woods, Kathleen Murkowski, Michael C. Spaeder, Matthew Sharron, Derek S. Wheeler, Eileen Beckman, Erin Frank, Kelli Howard, Christopher L. Carroll, Sholeen Nett, Deborah Jarvis, Vihas Patel, Renee A. Higgerson, LeeAnn M. Christie, Katri Typpo, Jean Deschênes, Aileen Kirby, Tim L. Uhl, Kyle J. Rehder, Ira M. Cheifetz, Sean P. Wrenn, K. Kypuros, Kurt D. Ackerman, Frank A. Maffei, G. Bloomquist, Nicole Rizkalla, Dai Kimura, Sachin S Shah, Christian Tigges, Fam Po Joen Su, Carolyn E. Barlow, Kelly N. Michelson, Katie K. Wolfe, Denise M. Goodman, Lesley V. Campbell, Lauren R. Sorce, Kaethan Bysani, Tracey Monjure, Matthew C. Evans, Balagangadhar Totapally, Madhuradhar Chegondi, Caravito Rodriguez, Joshua Frazier, Lisa Steele, Shirley Viteri, Andrew T. Costarino, Neal J. Thomas, Debra Spear, Eliotte L. Hirshberg, Jennifer Lilley, Courtney M. Rowan, Christi Rider, Jason M. Kane, Jerry J. Zimmerman, Christopher S. Greeley, John C. Lin, Reinhilde Jacobs, Margaret M. Parker, Kenneth W. Culver, Laura L. Loftis, Nancy Jaimon, Michelle Goldsworthy, Julie Fitzgerald, Scott T. Weiss, Vinay Nadkarni, Joseph P. Bush, Mary Ann DiLiberto, Claire Allen, Morris Gessouroun, Anil Sapru, Thomas Lang�, Mohamad Alkhouli, S Kamath, Damien Friel, Jennifer Daufeldt, Deyin D. Hsing, Costantino Di Carlo, Steven Pon, Jason Scimeme, Ahmed Shaheen, A. Hassinger, Hong Qiao, John S. Giuliano, Joana Tala, Daniela Vinciguerra, A. Fernandez, Rosalba Pardo Carrero, Pablo Vásquez‐Hoyos, Jairo Abel Gutiérrez Jaramillo, A Posada, L. Izquiierdo, Byron Enrique Piñeres-Olave, J. Donado, R. Dalmazzo, Sergio Rendich, L. Di Palma, Michelangelo Lapadula, Carlos Acuña, Pablo Cruces, Stephan Clément de Clety, M. Dujardin, Caroline Berghe, S. Renard, Jiří Žůrek, H. Steinherr, Katerina Mougkou, Elena Critselis, Katerina Mougkou, Matteo Di Nardo, Sergio Picardo, Francesca Tortora, Emanuele Rossetti, Tiziana Fragasso, Paola Cogo, Roberta Netto, Algirdas Dagys, Vaidotas Gurskis, Rimantas Kėvalas, C. Neeleman, Joris Lemson, C. Luijten, K. Wojciech, Izabela Pągowska‐Klimek, Maria Szczepańska, Jacek Karpe, Pedro Nunes, Helena Almeida, J.J. Ríos-Martín, Marco Vieira, J.P. García Íñiguez, P. Madurga Revilla, Javier Urbano, Jesús López‐Herce, Amaya Bustinza, Alba Palacios, Sylvia Belda Hofheinz, Antonio Rodríguez‐Núñez, Sonia Brió Sanagustín, Efrain Antonio Gonzalez, Mónica Riaza Gómez, R. Piaya, P Soler, Elisabeth Esteban, J. J. Laraudogoitia, Carlos Monge, V. Herrera, J. Granados, Claudio González, Tolga Köroğlu, Eda Özçelik, Paul Baines, Adrian Plunkett, PG Davis, Shane George, Shane M. Tibby, Jack Harris, Rachel Agbeko, R. Lampitt, Joe Brierley, Mark Peters, Andrew Jones, Troy E. Dominguez, T. Thiruchelvam, Akash Deep, Lloyd J Ridley, Wanda Bowen, Richard Levin, I. Macleod, Martin Gray, Nargis Hemat, J. W. Alexander, Sara Ali, John Pappachan, Jenni McCorkell, Peter‐Marc Fortune, M. J. MacDonald, Phil Hudnott, Suyun Qian, Sunit Singhi, Karthi Nallasamy, Rakesh Lodha, Nobuaki Shime, Yasuhiko Tabata, Osamu Saitô, Takanari Ikeyama, Tatsuya Kawasaki, Lucy Chai See Lum, A. Abidin, Stephen T. Kee, Shifang Tang, Rafidah Jalil, Yun Guan, Yao Liu, Katie Lin, John Ong, Asma Salloo, L Doedens, L R Mathivha, Gary Reubenson, S. Moaisi, Adéle Pentz, Robin Green, Andreas Schibler, A. Fernandez, Simon Erickson, J.A. McEneiry, Debbie Long, Tavey Dorofaeff, M G Coulthard, Jeremy Millar, Carmel Delzoppo, Ged Williams, Mary Lou Morritt, Nelson B. Watts, Mary Lou Morritt, John Beca, Claire Sherring, Thomas Bushell,

Hemodynamic Monitoring and Therapy

Background Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality. Methods Data were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality. Results A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death. Conclusions Pediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population.