Dataset Information

Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis.

ABSTRACT:

Background

The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.

Objective

We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.

Methods

We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n?=?252) were compared to subjects who did not receive corticosteroids (n?=?244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.

Results

Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p?=?0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p?=?0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.

Conclusions

Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

SUBMITTER: Atkinson SJ

PROVIDER: S-EPMC4227847 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis.

Atkinson Sarah J SJ Cvijanovich Natalie Z NZ Thomas Neal J NJ Allen Geoffrey L GL Anas Nick N Bigham Michael T MT Hall Mark M Freishtat Robert J RJ Sen Anita A Meyer Keith K Checchia Paul A PA Shanley Thomas P TP Nowak Jeffrey J Quasney Michael M Weiss Scott L SL Banschbach Sharon S Beckman Eileen E Howard Kelli K Frank Erin E Harmon Kelli K Lahni Patrick P Lindsell Christopher J CJ Wong Hector R HR

PloS one 20141111 11

<h4>Background</h4>The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.<h4>Objective</h4>We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.<h4>Methods</h4>We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were str ...[more]

PMID: 25386653

Similar Datasets

Project description:BackgroundSepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key drivers of SA-AKI. We sought to measure differences between endothelial dysfunction markers among children with and without SA-AKI, test whether this association varied across inflammatory biomarker-based risk strata, and develop prediction models to identify those at highest risk of SA-AKI.MethodsSecondary analyses of prospective observational cohort of pediatric septic shock. Primary outcome of interest was the presence of ≥ Stage II KDIGO SA-AKI on day 3 based on serum creatinine (D3 SA-AKI SCr). Biomarkers including those prospectively validated to predict pediatric sepsis mortality (PERSEVERE-II) were measured in Day 1 (D1) serum. Multivariable regression was used to test the independent association between endothelial markers and D3 SA-AKI SCr. We conducted risk-stratified analyses and developed prediction models using Classification and Regression Tree (CART), to estimate risk of D3 SA-AKI among prespecified subgroups based on PERSEVERE-II risk.ResultsA total of 414 patients were included in the derivation cohort. Patients with D3 SA-AKI SCr had worse clinical outcomes including 28-day mortality and need for CRRT. Serum soluble thrombomodulin (sTM), Angiopoietin-2 (Angpt-2), and Tie-2 were independently associated with D3 SA-AKI SCr. Further, Tie-2 and Angpt-2/Tie-2 ratios were influenced by the interaction between D3 SA-AKI SCr and risk strata. Logistic regression demonstrated models predictive of D3 SA-AKI risk performed optimally among patients with high- or intermediate-PERSEVERE-II risk strata. A 6 terminal node CART model restricted to this subgroup of patients had an area under the receiver operating characteristic curve (AUROC) 0.90 and 0.77 upon tenfold cross-validation in the derivation cohort to distinguish those with and without D3 SA-AKI SCr and high specificity. The newly derived model performed modestly in a unique set of patients (n = 224), 84 of whom were deemed high- or intermediate-PERSEVERE-II risk, to distinguish those patients with high versus low risk of D3 SA-AKI SCr.ConclusionsEndothelial dysfunction biomarkers are independently associated with risk of severe SA-AKI. Pending validation, incorporation of endothelial biomarkers may facilitate prognostic and predictive enrichment for selection of therapeutics in future clinical trials among critically ill children.

Dataset Information

Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis.

Background

Objective

Methods

Results

Conclusions

Publications

Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets