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Prognostic Factors in Pediatric Sepsis Study, From the Spanish Society of Pediatric Intensive Care

Pérez, David Vila MD*; Jordan, Iolanda PhD*; Esteban, Elisabeth*; García-Soler, Patricia MD; Murga, Vega MD; Bonil, Vanesa MD§; Ortiz, Irene MD; Flores, Carlos MD; Bustinza, Amaya MD**; Cambra, Francisco Jose PhD*

The Pediatric Infectious Disease Journal: February 2014 - Volume 33 - Issue 2 - p 152–157
doi: 10.1097/01.inf.0000435502.36996.72
Original Studies

Background: Sepsis and septic shock represent up to 30% of admitted patients in pediatric intensive care units, with a mortality that can exceed 10%. The objective of this study is to determine the prognostic factors for mortality in sepsis.

Methods: Multicenter prospective descriptive study with patients (aged 7 days to 18 years) admitted to the pediatric intensive care units for sepsis, between January 2011 and April 2012.

Results: Data from 136 patients were collected. Eighty-seven were male (63.9%). The median age was a year and a half (P25-75 0.3–5.5 years). In 41 cases (30.1%), there were underlying diseases. The most common etiology was Neisseria meningitidis (31 cases, 22.8%) followed by Streptococcus pneumoniae (16 patients, 11.8%). Seventeen cases were fatal (12.5%). In the statistical analysis, the factors associated with mortality were nosocomial infection (P = 0.004), hypotension (P <0.001) and heart and kidney failure (P < 0.001 and P = 0.004, respectively). The numbers of leukocytes, neutrophils and platelets on admission were statistically lower in the group that died (P was 0.006, 0.013 and <0.001, respectively). Multivariate analysis showed that multiple organ failure, neutropenia, purpura or coagulopathy and nosocomial infection were independent risk factors for increased mortality (odds ratio: 17, 4.9, 9 and 9.2, respectively).

Conclusions: Patients with sepsis and multiorgan failure, especially those with nosocomial infection or the presence of neutropenia or purpura, have a worse prognosis and should be monitored and treated early.

From the *Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona; Pediatric Intensive Care Unit Service, Hospital Carlos Haya, Málaga; Pediatric Intensive Care Unit Service, Hospital Universitario de Salamanca, Salamanca; §Pediatric Intensive Care Unit Service, Hospital Parc Taulí, Sabadell; Pediatric Intensive Care Unit Service, Hospital Virgen de la Salud, Toledo; Pediatric Intensive Care Unit Service, Hospital Puerta del Mar, Cádiz; and **Pediatric Intensive Care Unit Service, Hospital Gregorio Marañón, Madrid, Spain.

Accepted for publication August 2, 2013.

The study was carried out according to the Helsinki Declaration and was approved by the Sant Joan de Déu Ethical Committee. The authors declare no funding or conflicts of interest to disclose.

Author for correspondence: Iolanda Jordan Garcia, MD, PhD, Sant Joan de Déu Hospital, Paseo Sant Joan de Déu, 2, Esplugues de Llobregat, 08950 Barcelona, Spain. E-mail: ijordan@hsjdbcn.org.

© 2014 by Lippincott Williams & Wilkins, Inc.