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Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India

A Retrospective Study*

Sankar, Jhuma, MD; Dhochak, Nitin, MD; Kumar, Kiran, MD; Singh, Man, MD; Sankar, M. Jeeva, MD, DM; Lodha, Rakesh, MD

Pediatric Critical Care Medicine: March 2019 - Volume 20 - Issue 3 - p e122–e129
doi: 10.1097/PCC.0000000000001864
Online Clinical Investigations
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Objectives: To evaluate the proportion of children fulfilling “Sepsis-3” definition and International Pediatric Sepsis Consensus Conference definition among children diagnosed to have septic shock and compare the mortality risk between the two groups.

Design: Retrospective chart review.

Setting: PICU of a tertiary care teaching hospital from 2014 to 2017.

Patients: Children (≤ 17 yr old) with a diagnosis of septic shock at admission or during PICU stay.

Interventions: None.

Measurements and Main Results: We applied both International Pediatric Sepsis Consensus Conference and the new “Sepsis-3” definition (sepsis with hypotension requiring vasopressors and a lactate value of ≥ 2 mmol/L) to identify cases of septic shock by these definitions. Key outcomes such as mortality, proportion attaining shock reversal at 24 hours and organ dysfunction were compared between those fulfilling “Sepsis-3” definitions (“Sepsis-3” group) and those fulfilling “International Pediatric Sepsis Consensus Conference” definition (“International Pediatric Sepsis Consensus Conference” group). A total of 216 patients fulfilled International Pediatric Sepsis Consensus Conference definitions of septic shock. Of these, only 104 (48%; 95% CI, 42–55) fulfilled “Sepsis-3” definition. Children fulfilling “Sepsis-3 plus International Pediatric Sepsis Consensus Conference definitions” (“Sepsis-3 and International Pediatric Sepsis Consensus Conference” group) had lower proportion with shock resolution (61% vs 82%; relative risk, 0.73; 95% CI, 0.62–0.88) and higher risk of multiple organ dysfunction (85% vs 68%; 1.24; 1.07–1.45) at 24 hours. The mortality was 48.5% in “Sepsis-3 and International Pediatric Sepsis Consensus Conference” group as compared with 37.5% in the “International Pediatric Sepsis Consensus Conference only” group (relative risk, 1.3; 95% CI, 0.94–1.75).

Conclusions: Less than half of children with septic shock identified by International Pediatric Sepsis Consensus Conference definitions were observed to fulfill the criteria for shock as per “Sepsis-3” definitions. Lack of difference in the risk of mortality between children who fulfilled “Sepsis-3” definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of septic shock in children.

All authors: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

*See also p. 299.

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The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: jhumaji@gmail.com

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies