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Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

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收录情况: ◇ SCIE

作者:
机构: [1]Ohio State Univ, Dept Pediat Surg, Nationwide Childrens Hosp, Columbus, OH 43210 USA; [2]Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Div Crit Care Med,Dept Anesthesiol & Crit Care, Philadelphia, PA 19104 USA; [3]Univ Penn, Perelman Sch Med, Ctr Surg & Econ, Philadelphia, PA 19104 USA; [4]Penn State Univ, Coll Med, Penn State Hershey Childrens Hosp, Div Pediat Crit Care Med, Hershey, PA USA; [5]Ohio State Univ, Dept Pediat, Nationwide Childrens Hosp, Div Crit Care Med, Columbus, OH 43210 USA; [6]Montreal Childrens Hosp McGill, Montreal, PQ, Canada; [7]St Justine Hosp, Montreal, PQ, Canada; [8]BC Childrens Hosp, Vancouver, BC, Canada; [9]Hosp Cardiovasc Puerto Rico & Caribe, San Juan, PR USA; [10]San Jorge Childrens Hosp, San Juan, PR USA; [11]Univ Pediat Hosp, San Juan, PR USA; [12]Akron Childrens Hosp, Akron, OH USA; [13]Amplatz Childrens Hosp, Minneapolis, MN USA; [14]Arkansas Childrens Hosp, Little Rock, AR 72202 USA; [15]Boston Childrens Hosp, Boston, MA USA; [16]Childrens Hosp Pittsburgh, Pittsburgh, PA 15213 USA; [17]Childrens Hosp Hackensack, Hackensack, NJ USA; [18]Childrens Mercy Hosp, Kansas City, MO 64108 USA; [19]Childrens Healthcare Atlanta, Atlanta, GA USA; [20]Childrens Hosp Minnesota, Minneapolis, MN USA; [21]Childrens Hosp St Paul, St Paul, MN USA; [22]Childrens Hosp Colorado, Aurora, CO USA; [23]Childrens Hosp New Orleans, New Orleans, LA USA; [24]Childrens Hosp Los Angeles, Los Angeles, CA USA; [25]Childrens Hosp Monmouth, Long Branch, NJ USA; [26]Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA; [27]Childrens Natl Med Ctr, Washington, DC 20010 USA; [28]Cincinnati Childrens Med Ctr, Cincinnati, OH USA; [29]Connecticut Childrens, Hartford, CT USA; [30]Dartmouth Hitchcock, Dartmouth, NS, Canada; [31]Dayton Childrens Hosp, Dayton, OH USA; [32]Dell Childrens Med Ctr, Austin, TX USA; [33]Diamond Childrens Hosp, Tucson, AZ USA; [34]Doernbecher Childrens Hosp, Portland, OR USA; [35]Duke Childrens Hosp, Durham, NC USA; [36]El Paso Childrens Hosp, El Paso, TX USA; [37]Golisano Childrens Hosp, Rochester, MN USA; [38]Janet Weis Geisinger, Danville, PA USA; [39]Johns Hopkins, Baltimore, MD USA; [40]Le Bonheur Childrens Hosp, Memphis, TN USA; [41]Lucile Packard Childrens Hosp, Palo Alto, CA USA; [42]Lurie Childrens Hosp Chicago, Chicago, IL USA; [43]Med City Childrens Dallas, Dallas, TX USA; [44]Med Univ South Carolina, Charleston, SC 29425 USA; [45]Miami Childrens Hosp, Miami, FL USA; [46]Nationwide Childrens Hosp, Columbus, OH USA; [47]Nemours Alfred I duPont Childrens Hosp, Wilmington, DE USA; [48]Penn State Hershey Med Ctr, Hershey, PA USA; [49]Primary Childrens Med Ctr, Salt Lake City, UT 84103 USA; [50]Riley Hosp Children, Indianapolis, IN USA; [51]Rush Childrens Hosp, Chicago, IL USA; [52]Seattle Childrens Hosp, Seattle, WA USA; [53]St Louis Childrens Hosp, St Louis, MO 63178 USA; [54]SUNY Stony Brook, Stony Brook, NY 11794 USA; [55]Texas Childrens Hosp, Houston, TX 77030 USA; [56]Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA; [57]Univ Oklahoma, Med Ctr, Norman, OK 73019 USA; [58]Univ Calif San Francisco, San Francisco, CA 94143 USA; [59]Univ Iowa, Iowa City, IA 52242 USA; [60]Weill Cornell Med Ctr, New York, NY USA; [61]Wolfson Childrens Hosp, Jacksonville, FL USA; [62]Women & Childrens Hosp Buffalo, Buffalo, NY USA; [63]Yale Childrens Hosp, New Haven, CT USA; [64]Hosp Durand, Buenos Aires, DF, Argentina; [65]Clin Infantil Colsubsidio, Bogota, Colombia; [66]Hosp San Jose, Bogota, Colombia; [67]Hosp Gen Medellin, Medellin, Colombia; [68]Hosp Mil Cent, Bogota, Colombia; [69]Pablo Tobon Uribe, Medellin, Colombia; [70]Clin Las Condes, Las Condes, Chile; [71]Clin Santa Maria, Santiago, Chile; [72]Hosp Ninos Luis Calvo Mackenna, Santiago, Chile; [73]Hosp Padre Hurtado, Santiago, Chile; [74]St Luc Univ Hosp, Woluwe St Lambert, Belgium; [75]Masaryk Univ, Brno, Czech Republic; [76]Klinikum Augsburg, Augsburg, Germany; [77]Aghia Sophia Childrens Hosp, Athens, Greece; [78]PA Kyriakou Childrens Hosp, Athens, Greece; [79]Bambino Gesu Area Rossa, Naples, Italy; [80]Bambino Gesu Pediat, Naples, Italy; [81]Lithuanian Univ Hlth Sci, Kaunas, Lithuania; [82]Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands; [83]Polish Mother Mem Hosp, Lodz, Poland; [84]Szyszko Slaskiego Univ, Katowice, Poland; [85]Hosp Prof Dr Fernando Fonseca, Amadora, Portugal; [86]Ctr Hosp Lisboa Norte, Lisbon, Portugal; [87]Childrens Hosp Miguel Servet, Zaragoza, Spain; [88]Hosp Gen Univ Gregorio Maranon, Madrid, Spain; [89]Hosp 12 Octubre, Madrid, Spain; [90]Hosp Clin Univ, Madrid, Spain; [91]Hosp St Creu St Pau, Barcelona, Spain; [92]Hosp Univ Madrid, Madrid, Spain; [93]Hosp Carlos Haya Materno Infantil, Malaga, Spain; [94]Hosp St Joan de Deu, Barcelona, Spain; [95]Hosp Univ Donostia, Donostia San Sebastian, Gipuzkoa, Spain; [96]Hosp Univ Salamanca, Salamanca, Spain; [97]Hosp Virgen Arrixaca, Murcia, Spain; [98]Dokuz Eylul Univ, Izmir, Turkey; [99]Alder Hey Childrens Hosp, Liverpool, Merseyside, England; [100]Birmingham Childrens Hosp, Birmingham, W Midlands, England; [101]Bristol Royal Hosp Children, Bristol, Avon, England; [102]Evelina Childrens Hosp, London, England; [103]Great North Childrens Hosp Newcastle, Newcastle, England; [104]Great Ormond St, London, England; [105]Kings Coll Hosp London, London, England; [106]Royal Hosp Sick Children, London, England; [107]St George Hosp, London, England; [108]Univ Hosp North Staffordshire NHS Trust, Stoke On Trent, Staffs, England; [109]Univ Hosp Southampton NHS Fdn Trust, Southampton, Hants, England; [110]Royal Manchester Childrens Hosp, Manchester, Lancs, England; [111]Beijing Childrens Hosp, Beijing, Peoples R China; [112]All India Inst, New Delhi, India; [113]Tokyo Metropolitan, Tokyo, Japan; [114]Shizuoka Childrens Hosp, Shizuoka, Japan; [115]Univ Malaya, Med Ctr, Kuala Lumpur, Malaysia; [116]Kebangsaan Malaysia Med Ctr, Kuala Lumpur, Malaysia; [117]KK Womens & Childrens Hosp, Singapore, Singapore; [118]Natl Univ Singapore Hosp, Singapore, Singapore; [119]Chris Hani Baragwanath, Johannesburg, South Africa; [120]Rahima Moosa, Johannesburg, South Africa; [121]Steve Biko Acad Hosp, Pretoria, South Africa; [122]Mater Childrens Hosp, South Brisbane, Australia; [123]Princess Margaret Hosp, Toronto, ON, Canada; [124]Royal Childrens Hosp Brisbane, Brisbane, Qld, Australia; [125]Royal Childrens Melbourne, Melbourne, Vic, Australia; [126]Sydney Childrens Hosp, Sydney, NSW, Australia; [127]Childrens Hosp Westmead, Westmead, NSW, Australia; [128]Starship Childrens Hosp, Auckland, New Zealand; [129]Nationwide Childrens Hosp, Dept Surg, 700 Childrens Dr, Columbus, OH 43205 USA
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关键词: Pediatric sepsis Surgical sepsis Medical sepsis Mortality

摘要:
Background: Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality. Methods: Data were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality. Results: A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death. Conclusions: Pediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population. (C) 2019 Published by Elsevier Inc.

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出版当年[2018]版:
大类 | 4 区 医学
小类 | 3 区 外科
最新[2025]版:
大类 | 3 区 医学
小类 | 4 区 外科
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出版当年[2017]版:
Q2 SURGERY
最新[2023]版:
Q2 SURGERY

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第一作者:
第一作者机构: [1]Ohio State Univ, Dept Pediat Surg, Nationwide Childrens Hosp, Columbus, OH 43210 USA;
通讯作者:
通讯机构: [1]Ohio State Univ, Dept Pediat Surg, Nationwide Childrens Hosp, Columbus, OH 43210 USA; [129]Nationwide Childrens Hosp, Dept Surg, 700 Childrens Dr, Columbus, OH 43205 USA
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