Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS)

• Main Authors: Navin P. Boeddha, Luregn J. Schlapbach, Gertjan J. Driessen, Jethro A. Herberg, Irene Rivero-Calle, Miriam Cebey-López, Daniela S. Klobassa, Ria Philipsen, Ronald de Groot, David P. Inwald, Simon Nadel, Stéphane Paulus, Eleanor Pinnock, Fatou Secka, Suzanne T. Anderson, Rachel S. Agbeko, Christoph Berger, Colin G. Fink, Enitan D. Carrol, Werner Zenz, Michael Levin, Michiel van der Flier, Federico Martinón-Torres, Jan A. Hazelzet, Marieke Emonts, on behalf of the EUCLIDS consortium
• Format: Article
• Language: English
• Published: BMC 2018-05-01
• Series: Critical Care
• Subjects: Bacteremia; Meningococcal infections; Pneumococcal infections; Mortality; Morbidity
• Online Access: http://link.springer.com/article/10.1186/s13054-018-2052-7

Abstract Background Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability. Methods Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis. Results Patients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1–16.0, P = 0.04; disability OR 5.4, 95% CI 1.8–15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3–6.1, P < 0.01; disability OR 3.4, 95% CI 1.8–6.4, P < 0.001). Conclusions Despite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.