Abstract

Background

The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) developed and validated a definition of pediatric refractory septic shock (RSS), based on two septic shock scores (SSS). Both bedside SSS (bSSS) and computed SSS (cSSS) were found to be strongly associated with mortality. We aimed at assessing the accuracy of the RSS definition on a prospective cohort from India.

Methods

Post hoc analysis of a cohort issued from a double-blind randomized trial that compared first-line vasoactive drugs in children with septic shock. Sequential bSSS and cSSS from 60 children (single-center study, 53% mortality) were analyzed. The prognostic value of the ESPNIC RSS definition was tested for 28-day all-cause mortality.

Results

In this septic shock cohort, RSS was diagnosed in 35 patients (58.3%) during the first 24 h. Death occurred in 30 RSS patients (85.7% mortality) and in 2 non-RSS patients (8% mortality), OR = 60.9 [95% CI: 10.5–676.2], p < 0.001 with a median delay from sepsis onset of 3 days [1.0–6.7]. Among patients diagnosed with RSS, the mortality was not significantly different according to vasopressors randomization. Diagnosis of RSS with bSSS and cSSS had a high discrimination for death with an area under the receiver operating curve of 0.916 [95% CI: 0.843–0.990] and 0.925 [95% CI: 0.845–1.000], respectively. High prognostic accuracy of the bSSS was found in the first hours following intensive care admission. The best interval of prognostication occurs after the 12th hour following treatment initiation (AUC 0.973 [95% CI: 0.925–1.000]).

Conclusions

The ESPNIC refractory septic shock definition accurately identifies, within the first 6 h of septic shock management, children with lethal outcome.

Details

Title
Validation of the pediatric refractory septic shock definition: post hoc analysis of a controlled trial
Author
Morin, Luc 1 ; Ramaswamy, Karthik Narayanan 2 ; Muralidharan, Jayashree 2 ; Bansal Arun 2 ; Karthi, Nallasamy 2 ; Tissieres Pierre 3   VIAFID ORCID Logo  ; Singhi Sunit 2 

 Bicêtre Hospital, AP-HP Paris-Saclay University, Pediatric Intensive Care Unit, Le Kremlin-Bicêtre, France (GRID:grid.413784.d) (ISNI:0000 0001 2181 7253) 
 Post Graduate Institute of Medical Education and Research, Division of Pediatric Intensive and Emergency Care, Department of Pediatrics, Advanced Pediatrics Centre, Chandigarh, India (GRID:grid.415131.3) (ISNI:0000 0004 1767 2903) 
 Bicêtre Hospital, AP-HP Paris-Saclay University, Pediatric Intensive Care Unit, Le Kremlin-Bicêtre, France (GRID:grid.413784.d) (ISNI:0000 0001 2181 7253); CNRS, CEA, Paris Saclay University, Institute of Integrative Biology of the Cell, Gif-sur-Yvette, France (GRID:grid.457334.2) 
Publication year
2021
Publication date
Feb 2021
Publisher
Springer Nature B.V.
e-ISSN
21105820
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2488029088
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.