Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock
A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes. Prospective, cohort-outcom...
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| Vydáno v: | Critical care medicine Ročník 48; číslo 3; s. 319 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
United States
01.03.2020
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| ISSN: | 1530-0293, 1530-0293 |
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| Abstract | A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes.
Prospective, cohort-outcome study, conducted 2013-2017.
Twelve United States academic PICUs.
Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.
Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale.
In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3.
Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock. |
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| AbstractList | A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes.OBJECTIVESA companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes.Prospective, cohort-outcome study, conducted 2013-2017.DESIGNProspective, cohort-outcome study, conducted 2013-2017.Twelve United States academic PICUs.SETTINGTwelve United States academic PICUs.Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.PATIENTSCritically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale.INTERVENTIONSIllness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale.In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3.MEASUREMENTS AND MAIN RESULTSIn univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3.Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock.CONCLUSIONS AND RELEVANCEBiologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock. A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes. Prospective, cohort-outcome study, conducted 2013-2017. Twelve United States academic PICUs. Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support. Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale. In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3. Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock. |
| Author | Banks, Russell Zuppa, Athena Haaland, Wren Newth, Christopher J Sapru, Anil Zimmerman, Jerry J Dean, J Michael McQuillen, Patrick S Hall, Mark W Carcillo, Joseph A Reeder, Ron W Meert, Kathleen L Sorenson, Samuel Mourani, Peter M Holubkov, Richard Wong, Hector Chima, Ranjit S Whitlock, Kathryn Wessel, David Pollack, Murray M McGalliard, Julie Berg, Robert A Quasney, Michael Coleman, Whitney Varni, James W |
| Author_xml | – sequence: 1 givenname: Jerry J surname: Zimmerman fullname: Zimmerman, Jerry J organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA – sequence: 2 givenname: Russell surname: Banks fullname: Banks, Russell organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 3 givenname: Robert A surname: Berg fullname: Berg, Robert A organization: Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA – sequence: 4 givenname: Athena surname: Zuppa fullname: Zuppa, Athena organization: Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA – sequence: 5 givenname: Christopher J surname: Newth fullname: Newth, Christopher J organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA – sequence: 6 givenname: David surname: Wessel fullname: Wessel, David organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC – sequence: 7 givenname: Murray M surname: Pollack fullname: Pollack, Murray M organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC – sequence: 8 givenname: Kathleen L surname: Meert fullname: Meert, Kathleen L organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI – sequence: 9 givenname: Mark W surname: Hall fullname: Hall, Mark W organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH – sequence: 10 givenname: Michael surname: Quasney fullname: Quasney, Michael organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI – sequence: 11 givenname: Anil surname: Sapru fullname: Sapru, Anil organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA – sequence: 12 givenname: Joseph A surname: Carcillo fullname: Carcillo, Joseph A organization: Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA – sequence: 13 givenname: Patrick S surname: McQuillen fullname: McQuillen, Patrick S organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA – sequence: 14 givenname: Peter M surname: Mourani fullname: Mourani, Peter M organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Colorado, Denver, CO – sequence: 15 givenname: Hector surname: Wong fullname: Wong, Hector organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH – sequence: 16 givenname: Ranjit S surname: Chima fullname: Chima, Ranjit S organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH – sequence: 17 givenname: Richard surname: Holubkov fullname: Holubkov, Richard organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 18 givenname: Whitney surname: Coleman fullname: Coleman, Whitney organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 19 givenname: Samuel surname: Sorenson fullname: Sorenson, Samuel organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 20 givenname: James W surname: Varni fullname: Varni, James W organization: Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX – sequence: 21 givenname: Julie surname: McGalliard fullname: McGalliard, Julie organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA – sequence: 22 givenname: Wren surname: Haaland fullname: Haaland, Wren organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA – sequence: 23 givenname: Kathryn surname: Whitlock fullname: Whitlock, Kathryn organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA – sequence: 24 givenname: J Michael surname: Dean fullname: Dean, J Michael organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 25 givenname: Ron W surname: Reeder fullname: Reeder, Ron W organization: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32058369$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Contributor | Banks, Russell Yates, Andy Eaton, Micki Burr, Jeri Zuppa, Athena Wolfe, Ashley Haaland, Wren Flick, Kristi Sapru, Anil Dean, J. Michael Jayachandran, C J Stock, Emily Meert, Kathleen L Sorenson, Samuel Bell, Michael Kwok, Jeni Pawluszka, Ann Abraham, Alan Rick, Neda Whitlock, Kathryn Wessel, David Sierra, Yamila DiLiberto, Mary Ann McKenzie, Anne Chima, Ranjit McGalliard, Julie Lulic, Melanie Berg, Robert A Benken, Laura Merritt, Courtney Stoneman, Erin Quasney, Michael Reeder, Ron Rutebemberwa, Alle Steele, Lisa Carpenter, Todd Ratiu, Anna Koch, Leighann Hall, Mark Doctor, Alan Krallman, Kelli Zimmerman, Jerry J Rich, Deana Yunger, Toni Hession, Diane Mourani, Peter Shanley, Thomas Varni, James Newth, Christopher Carcillo, Joe Sullivan, Erin Yamakawa, Amy Tomanio, Elyse Holubkov, Richard Liu, Teresa Pollack, Murray Wong, Hector McQuillen, Patrick Salud, Derek Zetino, Yensy Twelves, Carolann Chen, Catherine Coleman, Whit Bisping, Stephanie Harrison, Rick Webster, Angie Hensley, Josey Flowers, Maggie Ladell, Diane Heidemann, Sabrina Berger, John |
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| DOI | 10.1097/CCM.0000000000004122 |
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| Discipline | Medicine |
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| SubjectTerms | Adolescent Bayes Theorem Child Child, Preschool Critical Illness - mortality Female Health Resources - statistics & numerical data Humans Infant Intensive Care Units, Pediatric - statistics & numerical data Male Organ Dysfunction Scores Prospective Studies Quality of Life Respiration, Artificial Severity of Illness Index Shock, Septic - mortality Shock, Septic - physiopathology Time Factors United States - epidemiology |
| Title | Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock |
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