TY - JOUR
T1 - Association of Pathogen Type with Outcomes of Children Encountering Community-Acquired Pediatric Septic Shock
AU - Salud, Derek
AU - Reeder, Ron W.
AU - Banks, Russell K.
AU - Meert, Kathleen L.
AU - Berg, Robert A.
AU - Zuppa, Athena
AU - Newth, Christopher J.
AU - Hall, Mark W.
AU - Quasney, Michael
AU - Sapru, Anil
AU - Carcillo, Joseph A.
AU - McQuillen, Patrick S.
AU - Mourani, Peter M.
AU - Varni, James W.
AU - Zimmerman, Jerry J.
N1 - Funding Information:
No performance site investigators disclose financial interests, activities, relationships, or affiliations that could be construed as real or potential conflicts of interest related to the article or the related investigation. Dr. Varni holds the copyright and the trademark for the Pediatric Quality of Life Inventory (PedsQL) and receives financial compensation from the Mapi Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the PedsQL. Dr Varni provided consultation on original study design and final article edits, but he played no role in data acquisition or analysis. Drs. Salud’s, Banks’, Carcillo’s, and Zimmerman’s institutions received funding from the National Institute of Child Health and Human Development. Drs. Salud, Reeder, Banks, Meert, Berg, Zuppa, Newth, Hall, Sapru, Carcillo, McQuillen, Mourani, Varni, and Zimmerman received support for article research from the National Institutes of Health (NIH). Drs. Reeder’s, Meert’s, Berg’s, Zuppa’s, Hall’s, McQuillen’s, Mourani’s, and Varni’s institutions received funding from the NIH. Dr. Banks disclosed government work. Dr. Newth received funding from Philips Research North America, Hamilton Medical, and Nihon Kohden. Dr. Hall received funding from Abbvie, La Jolla Pharmaceuticals, and Kiadis. Dr. Carcillo’s institution received funding from the National Institute of General Medical Sciences. Dr. Zimmerman’s institution received funding Immunexpress; he received funding from Elsevier Publishing. Dr. Quasney has disclosed that he does not have any potential conflicts of interest.
Funding Information:
Supported, in part, by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, R01HD073362, for Life After Pediatric Sepsis Evaluation, and was supported, in part, by the following cooperative agreements: UG1HD050096, UG1HD049981, UG1HD049983, UG1HD063108, UG1HD083171, UG1HD083166, UG1HD083170, U10HD050012, U10HD063106, and U01HD049934. Dr. Reeder is supported by R03HD104001 for secondary analyses of the LAPSE database.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - 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.
AB - 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.
KW - functional status
KW - health-related quality of life
KW - infection pathogens
KW - patient-centered outcomes
KW - septic shock
UR - http://www.scopus.com/inward/record.url?scp=85139375548&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000003001
DO - 10.1097/PCC.0000000000003001
M3 - Article
C2 - 35687094
AN - SCOPUS:85139375548
VL - 23
SP - 635
EP - 645
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 8
ER -