Critical illness factors associated with long- term mortality and health-related quality of life morbidity following community-acquired pediatric septic shock

Jerry J. Zimmerman, Russell Banks, Robert A. Berg, Athena Zuppa, Christopher J. Newth, David Wessel, Murray M. Pollack, Kathleen L. Meert, Mark W. Hall, Michael Quasney, Anil Sapru, Joseph A. Carcillo, Patrick S. McQuillen, Peter M. Mourani, Hector Wong, Ranjit S. Chima, Richard Holubkov, Whitney Coleman, Samuel Sorenson, James W. VarniJulie McGalliard, Wren Haaland, Kathryn Whitlock, J. Michael Dean, Ron W. Reeder

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Objectives: A companion article reports the trajectory of longterm mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes. Design: Prospective, cohort-outcome study, conducted 2013- 2017. Setting: Twelve United States academic PICUs. Patients: Critically ill children, 1 month to 18 years, with community- acquired septic shock requiring vasoactive-inotropic support. Interventions: Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale. Measurements and Main Results: In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactiveinotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/ per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of healthrelated quality of life at month 3. Conclusions and Relevance: Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock.

Original languageEnglish
Pages (from-to)319-328
Number of pages10
JournalCritical Care Medicine
Volume48
Issue number3
DOIs
StatePublished - Mar 2020

Keywords

  • Children
  • Critical illness variables
  • Health-related quality of life morbidity
  • Mortality
  • Organ dysfunction
  • Septic shock

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