Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock
In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-rela...
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| Veröffentlicht in: | Critical care medicine Jg. 48; H. 3; S. 329 |
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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United States
01.03.2020
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| ISSN: | 1530-0293, 1530-0293 |
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| Abstract | In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quality of life morbidity for children encountering community-acquired septic shock.
Prospective, cohort-outcome study, conducted 2013-2017.
Twelve academic PICUs in the United States.
Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.
Demographic, infection, illness severity, organ dysfunction, and resource utilization data were collected daily during PICU admission. Serial parent proxy-report health-related quality of life assessments were obtained at baseline, 7 days, and 1, 3, 6, and 12 months following PICU admission utilizing the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale.
Among 389 children enrolled, mean age was 7.4 ± 5.8 years; 46% were female; 18% were immunocompromised; and 51% demonstrated chronic comorbidities. Baseline Pediatric Overall Performance Category was normal in 38%. Median (Q1-Q3) Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores at PICU admission were 11.0 (6.0-17.0) and 9.0 (6.0-11.0); durations of vasoactive-inotropic and mechanical ventilation support were 3.0 days (2.0-6.0 d) and 8.0 days (5.0-14.0 d); and durations of PICU and hospital stay were 9.4 days (5.6-15.4 d) and 15.7 days (9.2-26.0 d). At 1, 3, 6, and 12 months following PICU admission for the septic shock event, 8%, 11%, 12%, and 13% of patients had died, while 50%, 37%, 30%, and 35% of surviving patients had not regained their baseline health-related quality of life.
This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality of life morbidity among children encountering community-acquired septic shock. Although in-hospital mortality was 9%, 35% of survivors demonstrated significant, health-related quality of life deterioration from baseline that persisted at least 1 year following hospitalization for septic shock. |
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| AbstractList | In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quality of life morbidity for children encountering community-acquired septic shock.
Prospective, cohort-outcome study, conducted 2013-2017.
Twelve academic PICUs in the United States.
Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.
Demographic, infection, illness severity, organ dysfunction, and resource utilization data were collected daily during PICU admission. Serial parent proxy-report health-related quality of life assessments were obtained at baseline, 7 days, and 1, 3, 6, and 12 months following PICU admission utilizing the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale.
Among 389 children enrolled, mean age was 7.4 ± 5.8 years; 46% were female; 18% were immunocompromised; and 51% demonstrated chronic comorbidities. Baseline Pediatric Overall Performance Category was normal in 38%. Median (Q1-Q3) Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores at PICU admission were 11.0 (6.0-17.0) and 9.0 (6.0-11.0); durations of vasoactive-inotropic and mechanical ventilation support were 3.0 days (2.0-6.0 d) and 8.0 days (5.0-14.0 d); and durations of PICU and hospital stay were 9.4 days (5.6-15.4 d) and 15.7 days (9.2-26.0 d). At 1, 3, 6, and 12 months following PICU admission for the septic shock event, 8%, 11%, 12%, and 13% of patients had died, while 50%, 37%, 30%, and 35% of surviving patients had not regained their baseline health-related quality of life.
This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality of life morbidity among children encountering community-acquired septic shock. Although in-hospital mortality was 9%, 35% of survivors demonstrated significant, health-related quality of life deterioration from baseline that persisted at least 1 year following hospitalization for septic shock. In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quality of life morbidity for children encountering community-acquired septic shock.OBJECTIVESIn-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quality of life morbidity for children encountering community-acquired septic shock.Prospective, cohort-outcome study, conducted 2013-2017.DESIGNProspective, cohort-outcome study, conducted 2013-2017.Twelve academic PICUs in the United States.SETTINGTwelve academic PICUs in the United States.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.Demographic, infection, illness severity, organ dysfunction, and resource utilization data were collected daily during PICU admission. Serial parent proxy-report health-related quality of life assessments were obtained at baseline, 7 days, and 1, 3, 6, and 12 months following PICU admission utilizing the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale.INTERVENTIONSDemographic, infection, illness severity, organ dysfunction, and resource utilization data were collected daily during PICU admission. Serial parent proxy-report health-related quality of life assessments were obtained at baseline, 7 days, and 1, 3, 6, and 12 months following PICU admission utilizing the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale.Among 389 children enrolled, mean age was 7.4 ± 5.8 years; 46% were female; 18% were immunocompromised; and 51% demonstrated chronic comorbidities. Baseline Pediatric Overall Performance Category was normal in 38%. Median (Q1-Q3) Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores at PICU admission were 11.0 (6.0-17.0) and 9.0 (6.0-11.0); durations of vasoactive-inotropic and mechanical ventilation support were 3.0 days (2.0-6.0 d) and 8.0 days (5.0-14.0 d); and durations of PICU and hospital stay were 9.4 days (5.6-15.4 d) and 15.7 days (9.2-26.0 d). At 1, 3, 6, and 12 months following PICU admission for the septic shock event, 8%, 11%, 12%, and 13% of patients had died, while 50%, 37%, 30%, and 35% of surviving patients had not regained their baseline health-related quality of life.MEASUREMENTS AND MAIN RESULTSAmong 389 children enrolled, mean age was 7.4 ± 5.8 years; 46% were female; 18% were immunocompromised; and 51% demonstrated chronic comorbidities. Baseline Pediatric Overall Performance Category was normal in 38%. Median (Q1-Q3) Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores at PICU admission were 11.0 (6.0-17.0) and 9.0 (6.0-11.0); durations of vasoactive-inotropic and mechanical ventilation support were 3.0 days (2.0-6.0 d) and 8.0 days (5.0-14.0 d); and durations of PICU and hospital stay were 9.4 days (5.6-15.4 d) and 15.7 days (9.2-26.0 d). At 1, 3, 6, and 12 months following PICU admission for the septic shock event, 8%, 11%, 12%, and 13% of patients had died, while 50%, 37%, 30%, and 35% of surviving patients had not regained their baseline health-related quality of life.This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality of life morbidity among children encountering community-acquired septic shock. Although in-hospital mortality was 9%, 35% of survivors demonstrated significant, health-related quality of life deterioration from baseline that persisted at least 1 year following hospitalization for septic shock.CONCLUSIONSThis investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality of life morbidity among children encountering community-acquired septic shock. Although in-hospital mortality was 9%, 35% of survivors demonstrated significant, health-related quality of life deterioration from baseline that persisted at least 1 year following hospitalization for 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/32058370$$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 Ashtari, 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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| References | 32058379 - Crit Care Med. 2020 Mar;48(3):426-428. doi: 10.1097/CCM.0000000000004230 |
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| SubjectTerms | Adolescent Age Factors Child Child, Preschool Community-Acquired Infections Comorbidity Female Health Resources - statistics & numerical data Hospital Mortality Humans Infant Intensive Care Units, Pediatric - statistics & numerical data Length of Stay - statistics & numerical data Longitudinal Studies Male Organ Dysfunction Scores Prospective Studies Quality of Life Respiration, Artificial - statistics & numerical data Sepsis - mortality Severity of Illness Index Shock, Septic - mortality Socioeconomic Factors United States - epidemiology |
| Title | Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock |
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