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
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.
| Errataetall: |
CommentIn: Pediatr Crit Care Med. 2019 Mar;20(3):299-300. - PMID 30830023 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
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| Enthalten in: |
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies - 20(2019), 3 vom: 01. März, Seite e122-e129 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sankar, Jhuma [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 04.05.2020 Date Revised 05.05.2020 published: Print CommentIn: Pediatr Crit Care Med. 2019 Mar;20(3):299-300. - PMID 30830023 Citation Status MEDLINE |
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| doi: |
10.1097/PCC.0000000000001864 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Sankar, Jhuma |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India |b A Retrospective Study |
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| 500 | |a Date Revised 05.05.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Pediatr Crit Care Med. 2019 Mar;20(3):299-300. - PMID 30830023 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a DESIGN: Retrospective chart review | ||
| 520 | |a SETTING: PICU of a tertiary care teaching hospital from 2014 to 2017 | ||
| 520 | |a PATIENTS: Children (≤ 17 yr old) with a diagnosis of septic shock at admission or during PICU stay | ||
| 520 | |a INTERVENTIONS: None | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Kumar, Kiran |e verfasserin |4 aut | |
| 700 | 1 | |a Singh, Man |e verfasserin |4 aut | |
| 700 | 1 | |a Sankar, M Jeeva |e verfasserin |4 aut | |
| 700 | 1 | |a Lodha, Rakesh |e verfasserin |4 aut | |
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