Dataset Information

A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis.

ABSTRACT: OBJECTIVES:We tested the hypothesis that a C-reactive protein and ferritin-based systemic inflammation contingency table can track mortality risk in pediatric severe sepsis. DESIGN:Prospective cohort study. SETTING:Tertiary PICU. PATIENTS:Children with 100 separate admission episodes of severe sepsis were enrolled. INTERVENTIONS:Blood samples were attained on day 2 of sepsis and bi-weekly for biomarker batch analysis. A 2?×?2 contingency table using C-reactive protein and ferritin thresholds was developed. MEASUREMENTS AND MAIN RESULTS:A C-reactive protein of 4.08?mg/dL and a ferritin of 1,980?ng/mL were found to be optimal cutoffs for outcome prediction at first sampling (n = 100) using the Youden index. PICU mortality was increased in the "high-risk" C-reactive protein greater than or equal to 4.08?mg/dL and ferritin greater than or equal to 1,980?ng/mL category (6/13 [46.15%]) compared with the "intermediate-risk" C-reactive protein greater than or equal to 4.08?mg/dL and ferritin less than 1,980?ng/mL or C-reactive protein less than 4.08?mg/dL and ferritin greater than or equal to 1,980?ng/mL categories (2/43 [4.65%]), and the "low-risk" C-reactive protein less than 4.08?mg/dL and ferritin less than 1,980?ng/mL category (0/44 [0%]) (odds ratio, 36.43 [95% CI, 6.16-215.21]). The high-risk category was also associated with the development of immunoparalysis (odds ratio, 4.47 [95% CI, 1.34-14.96]) and macrophage activation syndrome (odds ratio, 24.20 [95% CI, 5.50-106.54]). Sixty-three children underwent sequential blood sampling; those who were initially in the low-risk category (n = 24) and those who subsequently migrated (n = 19) to the low-risk category all survived, whereas those who remained in the "at-risk" categories had increased mortality (7/20 [35%]; p < 0.05). CONCLUSIONS:A C-reactive protein- and ferritin-based contingency table effectively assessed mortality risk. Reduction in systemic inflammation below a combined threshold C-reactive protein of 4.08?mg/dL and ferritin of 1,980?ng/mL appeared to be a desired response in children with severe sepsis.

SUBMITTER: Carcillo JA

PROVIDER: S-EPMC5291785 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

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A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis.

Carcillo Joseph A JA Sward Katherine K Halstead E Scott ES Telford Russell R Jimenez-Bacardi Adria A Shakoory Bita B Simon Dennis D Hall Mark M

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20170201 2

<h4>Objectives</h4>We tested the hypothesis that a C-reactive protein and ferritin-based systemic inflammation contingency table can track mortality risk in pediatric severe sepsis.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Tertiary PICU.<h4>Patients</h4>Children with 100 separate admission episodes of severe sepsis were enrolled.<h4>Interventions</h4>Blood samples were attained on day 2 of sepsis and bi-weekly for biomarker batch analysis. A 2 × 2 contingency table using C-reactive ...[more]

PMID: 27941423

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Project description:ObjectivesTo assess the prevalence of immunocompromised diagnoses among children with severe sepsis and septic shock, and to determine the association between immunocompromised diagnoses and clinical outcomes after adjustment for demographics and illness severity.DesignRetrospective multicenter cohort study.SettingEighty-three centers in the Virtual Pediatric Systems database.PatientsChildren with severe sepsis or septic shock admitted to a participating PICU between January 1, 2012, and December 31, 2016.InterventionsNone.Measurements and main resultsAcross 83 centers, we identified 10,768 PICU admissions with an International Classification of Diseases, 9th Revision, Clinical Modification code for severe sepsis or septic shock; 3,021 of these patients (28%) had an immunocompromised diagnosis. To evaluate variation across centers and determine factors associated with PICU mortality, we used mixed-effect logistic regression models. Among patients without hematopoietic cell transplant, congenital immunodeficiency (adjusted odds ratio, 1.90; 95% CI, 1.24-2.92), multiple prior malignancies (adjusted odds ratio, 1.86; 95% CI, 1.15-2.99), and hemophagocytic lymphohistiocytosis (adjusted odds ratio, 3.09; 95% CI, 1.91-4.98) were associated with an increased odds of PICU mortality. Among patients with prior hematopoietic cell transplant, liquid malignancy (adjusted odds ratio, 3.15; 95% CI, 2.09-4.74), congenital immunodeficiency (adjusted odds ratio, 6.94; 95% CI, 3.84-12.53), multiple prior malignancies (adjusted odds ratio, 3.54; 95% CI, 1.80-6.95), and hemophagocytic lymphohistiocytosis (adjusted odds ratio, 2.79; 95% CI, 1.36-5.71) were associated with an increased odds of PICU mortality. PICU mortality varied significantly by center, and a higher mean number of sepsis patients per month in a center was associated with lower PICU mortality (adjusted odds ratio, 0.94; 95% CI, 0.90-0.98). PICU resource utilization varied by immunocompromised diagnosis and history of hematopoietic cell transplant, and among survivors immunocompromised patients have shorter median PICU length of stay compared with patients without immunocompromised diagnoses (p < 0.001).ConclusionsImmunocompromised diagnoses are present in 28% of children with severe sepsis or septic shock. Multiple prior malignancies, hemophagocytic lymphohistiocytosis, congenital immunodeficiency, and hematopoietic cell transplant are independently associated with an increased odds of PICU mortality in children with severe sepsis or septic shock. Significant variation exists in PICU mortality among centers despite adjustment for immunocompromised diagnoses, known risk factors for sepsis-related mortality, and center-level sepsis volume.

Dataset Information

A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis.

Publications

A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis.

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