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Interactions of Sepsis, Organ Dysfunction, and Outcome of Critically Ill Children

We read with great interest the article by Leclerc and colleagues (1) about the influence of organ dysfunction and sepsis on outcome of critically ill children. We had previously evaluated (from 2001 to 2003) this issue (2), using organ dysfunction criteria adapted from Wilkinson and coworkers (3) at PICU admission. Our findings were similar to those reported by Leclerc and colleagues (1), with sepsis significantly influencing the outcome of children with MODS. However, we found in our study that the main discrepancy in outcome was between children with two and three organ dysfunctions, and not between children with one and two organ dysfunctions. We, therefore, evaluated the effect of sepsis on the outcome of children with three or more organ dysfunctions (MODS-3). Surprisingly, we found no effect of sepsis on the outcome of children with MODS-3. In their study, Leclerc and coworkers also noticed a more pronounced difference in mortality between children with two and three organ dysfunctions.

It would be interesting to know if sepsis also affected the outcome of children with three or more organ dysfunctions. Perhaps it is not the interaction of sepsis and MODS that has changed from the early reports (4), but the definition of MODS that has became obsolete nearly 20 years after its initial description. Studies on inflammatory response indirectly support this hypothesis (5). It may be that using a definition of multiple organ dysfunction syndrome that requires the presence of three or more organ dysfunctions better reflects the effect of organ dysfunctions on outcome of children in PICU at the present time.

Ricardo Garcia Branco, Pedro Celiny R. Garcia, Joao Pedro T. Garcia and Jefferson P. Piva

HSL da PUCRS Porto Alegre, Brazil

Robert Ross-Russell

Addenbrookes Hospital Cambridge, United Kingdom

FOOTNOTES

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Leclerc F, Leteurtre S, Duhamel A, Grandbastien B, Proulx F, Martinot A, Gauvin F, Hubert P, Lacroix J. Cumulative influence of organ dysfunctions and septic state on mortality of critically ill children. Am J Respir Crit Care Med 2005;171:348–353.[Abstract/Free Full Text]
2. Branco R, Garcia JP, Bruno F, Einloft P, Piva JP, Garcia PCR. Effect of Multiple Organ Dysfunction and sepsis in children admitted to a PICU. Proceedings of the IX Brazilian Congress in Pediatric Intensive Care and VI Latin-American Congress of Pediatric Intensive Care; Oct. 5–8, 2004; Porto Alegre, Brasil. Scientia Médica 2004;14(S1):25.
3. Wilkinson JD, Pollack MM, Ruttimann UE, Glass NL, Yeh TS. Outcome of pediatric patients with multiple organ system failure. Crit Care Med 1986;14:271–274.[Medline]
4. Wilkinson JD, Pollack MM, Glass NL, Kanter RK, Katz RW, Steinhart CM. Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr 1987;111:324–328.[CrossRef][Medline]
5. Whalen MJ, Doughty LA, Carlos TM, Wisniewski SR, Kochanek PM, Carcillo JA. Intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 are increased in the plasma of children with sepsis-induced multiple organ failure. Crit Care Med 2000;28:2600–2607.[CrossRef][Medline]

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