Association of Pathogen Type with Outcomes of Children Encountering Community-Acquired Pediatric Septic Shock

Derek Salud, Ron W. Reeder, Russell K. Banks, Kathleen L. Meert, Robert A. Berg, Athena Zuppa, Christopher J. Newth, Mark W. Hall, Michael Quasney, Anil Sapru, Joseph A. Carcillo, Patrick S. McQuillen, Peter M. Mourani, James W. Varni, Jerry J. Zimmerman

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

OBJECTIVES: To determine the association of pathogen type with mortality, functional status, and health-related quality of life (HRQL) among children at hospital discharge/1 month following hospitalization for septic shock. DESIGN: Secondary database analysis of a prospective, descriptive cohort investigation. SETTING: Twelve academic PICUs in the United States. PATIENTS: Critically ill children, 1 month to 18 years old, enrolled from 2013 to 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Association of clinical outcomes with pathogen type was assessed for all patients and separately for surviving patients enrolled in the primary Life After Pediatric Sepsis Evaluation (LAPSE) investigation. For this secondary analysis, we predicted that age would be associated with pathogen type and outcomes, and accordingly, it was incorporated as a confounding variable in primary analyses. Among 389 children enrolled with septic shock, at 1 month/hospital discharge, we observed no statistically significant differences in relation to pathogen types for the composite outcome mortality or substantial new functional morbidity: no causative organism identified (27% [28/103]), pure viral infections (26% [24/91]), pure bacterial/fungal infections (25% [31/125]), and bacterial/fungal+viral coinfections (33% [23/70]). Similarly, we observed no statistically significant differences in relation to pathogen types for the composite outcome, mortality, or persistent serious deterioration of HRQL: no causative organism identified (43% [44/103]), pure viral infections (33% [30/91]), pure bacterial/fungal infections (46% [57/125]), and bacterial/fungal+viral coinfections (43% [30/70]). However, we did identify statistically significant associations between pathogen type and the outcome ventilator-free days (p = 0.0083) and PICU-free days (0.0238). CONCLUSIONS: This secondary analysis of the LAPSE database identified no statistically significant association of pathogen type with composite mortality and morbidity outcomes. However, pathogen type may be associated with PICU resources employed to treat sepsis organ dysfunction. Ultimately, pediatric septic shock was frequently associated with adverse patient-centered, clinically meaningful outcomes regardless of infectious disease pathogen type.

Original languageEnglish
Pages (from-to)635-645
Number of pages11
JournalPediatric Critical Care Medicine
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2022

Keywords

  • functional status
  • health-related quality of life
  • infection pathogens
  • patient-centered outcomes
  • septic shock

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