Descriptive statistics and risk factor analysis of children with community-acquired septic shock

Journal of Intensive Care

Research

Hideo Yasunaga¹  Hiroki Matsui¹  Kiyohide Fushimi²  Nobuaki Michihata³  Yohei Hashimoto⁴  Shinya Miura⁵ 

[1] Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan;Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan;Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan;Department of Pediatrics, St. Marianna University School of Medicine, 2 Chome-16-1 Sugao, Miyamae Ward, Kawasaki, Kanagawa, Japan;Teikyo University Graduate School of Public Health, Tokyo, Japan;

关键词: Sepsis;    Septic shock;    Community-acquired;    Epidemiology;    Children;    Pediatric;   

DOI  :  10.1186/s40560-023-00652-9

 received in 2022-12-15, accepted in 2023-01-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundChildren with community-acquired septic shock can rapidly deteriorate and die in acute-care hospitals. This study aimed to describe the mortality, timing, and risk factors in children with community-acquired septic shock.MethodsThis is a retrospective cohort study using a national inpatient database in Japan. The study population included children (age < 20 years) who were admitted to acute-care hospitals with a diagnosis of sepsis from July 2010 to March 2020, who were treated with antibiotics, and who were supported with vasoactive drugs within three days of hospitalization. We used a Cox proportional-hazards regression model to identify risk factors for earlier death.ResultsAmong 761 eligible children, the median age was 3 (interquartile range, 0–11) years and 57.2% had underlying conditions. Among these, 67.1% were admitted to accredited intensive care units within three days of hospitalization and 38.6% were transported from other hospitals. The median hospital volume, defined as the number of eligible children in each hospital over the study period, was 4 (interquartile range, 2–11). Overall, 244 children died (in-hospital mortality rate, 32.1%). Among them, 77 (31.6%) died on the first day, and 156 (63.9%) died within three days of hospitalization. A Cox proportional-hazards regression model showed that earlier death was associated with lower hospital volume and age 1–5 years, whereas it was inversely associated with admission to an accredited intensive care unit and transport from other hospitals. Among 517 survivors, 178 (34.4%) were discharged with comorbidities.ConclusionsChildren with community-acquired septic shock had high mortality, and early death was common. Our findings may warrant future efforts to enhance the quality of initial resuscitation for sepsis in low-volume hospitals and to ensure a healthcare system in which children with sepsis can be treated in accredited intensive care units.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 1