Title: Clinical, Demographic Profile and Outcome of Children Admitted in PICU with A Diagnosis of Severe Sepsis and Septic Shock

Authors: Ghimire Jagat Jeevan, Gami Fakir Chandra, Thapa Surya Bahadur

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.40

Abstract

Background: To determine profile and outcome of children with severe sepsis and/or septic shock.

Material and Methodology: The prospective observational study was done in 47 children with severe sepsis and septic shock admitted in PICU. Demographic data, clinical finding, lactate at admission and lactate clearance and PRISMIII score were recorded. The patients were followed daily, maximum up to 5 days or till death or discharge from PICU. PRISM III was correlated with in-hospital mortality and morbidity.

Results: Out of 234 patients admitted 57(24%) had the diagnosis of sepsis.47 patients were included in the study. Male female ratio was 1.76:1.Mean age of patients was 88.79 months. Mean duration of illness was 7.13 days. Pneumonia was the most common diagnosis. Mean length of PICU stay was 160 hours and mortality was 25%.Nonsurvivors didn’t differ from survivors in terms of age, duration of illness, platelet count, lactate at admission and lactate clearance. Survivors differed from non-survivors in terms of PRISM III score (19.77 vs 36.33) with p-value of .003. PRISMIII had excellent accuracy of death prediction of death with AUC of 0 .852(95% CI 0.702-0.900)

Conclusion: Sepsis remain as leading cause of mortality in PICU.PRISMIII had the excellent prediction of death.

Keywords:  PRISMIII, Severe Sepsis, Septic shock, PICU.

References

  1. Carcillo JA. Reducing the global burden of sepsis in infants and children: a clinical practice research agenda. Pediatr Crit Care Med.2005 May 6 ,S157-64.
  2. Deborah Farrel and Simon Nadel .What’s New in Paediatric Sepsis? Curr Pediatr Rep. 2016(4) 1–5.
  3. Bryce J, Cynthia Boschi Pinto, Shibuya K ,Black RE. WHO estimates of the causes of death in children.2005 Mar 26-Apr 1;365(9465):1147-52.
  4. Goldstein B, Giroir B ,Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics.Pediatr Crit Care Med.2005 Jan;6(1):2-8
  5. Dellinger RP, Levy Mm - Rhodes A, Rhodes A - Annane D, Annane D - Gerlach H et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.Crit Care Med.2013 Feb;41(2):580-637.
  6. Khan MR, Maheshwari PK ,Masood K , Qamar FN,Haque AU. Epidemiology and outcome of sepsis in a tertiary care PICU of Pakistan.Indian J Pediatr.2012 Nov;79(11):1454-8
  7. Khilnani P, Singhi S Lodha R, Lodha R  - Santhanam I, Santhanam I,Sachdev A ,Chugh K, Jaishree M, et al. Pediatric Sepsis Guidelines: Summary for resource-limited countries.Indian J Crit Care Med. 2010 Jan;14(1):41-52
  8. Jaramillo-Bustamante JC, Marin-Agudelo A,Fernandez-Laverde M, Fernandez-Laverde M Bareno-Silva J, Bareno-Silva J. Epidemiology of sepsis in pediatric intensive care units: first Colombian multicenter study. Pediatr Crit Care Med.  2012 Sep;13(5):501-8.
  9. Watson RS, Carcillo Ja ,Linde-Zwirble WT,Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States.Am J Respir Crit Care Med.2003 Mar 167(5):695-701
  10. Kutko MC, Flaherty MB, Helmrich RF, Ushay HM, Pon S, Greenwald BM, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure,Pediatr Crit Care Med. 2003 Jul;4(3):333-7
  11. Shime N, Kawasaki T ,Saito O, Akamine Y, Toda Y, Takeuchi M, Sugimura H, et al. Incidence and risk factors for mortality in paediatric severe sepsis: results from the national paediatric intensive care registry in Japan.Intensive Care Med.2012 Jul;38 (7):1191-7.
  12. de Souza DC, Shieh H,Barreira ER, Ventura AMC, Bousso A, Troster EJ.Epidemiology of Sepsis in Children Admitted to PICUs in South America. Pediatr Crit Care Med.2016 Aug;17(8) :727-34
  13. Munde AKumar NBeri RSPuliyel JMLactate Clearance as a Marker of Mortality in PediatricIntensive Care Unit. Indian Pediatr.2014 Jul;51(7):565-7
  14. Khilnani P, Sarma D Singh R, Uttam R, Rajdev S, Makkar A, Kaur J, et al. Demographic profile and outcome analysis of a tertiary level pediatric intensive care unitIndian J Pediatr.2004 Jul;71(7):587-91
  15. Kana Ram Jat UJ, and Vinod K. Gupta. Serum lactate levels as the predictor of outcome in pediatric septic shock. Indian J Crit Care Med, 2011;15(2):102-7.
  16. Kim YA, Ha Ej,Jhang WK, Jhang ,Park SJ. Early blood lactate area as a prognostic marker in pediatric septic shock.Intensive Care Med.2013 Oct;39(10):1818-23
  17. Gurpreet Kaur NV, Kundan Mittal, Jaya Shankar Kaushik, and Mohammad Aamir. Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study Indian J Crit Care Med. 2014 Jul;18(7):437-41

Corresponding Author

Ghimire Jagat Jeevan

Kanti children Hospital, Kathmandu

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.