Published ahead of print on October 29, 2004, doi:10.1164/rccm.200405-630OC
Am. J. Respir. Crit. Care Med., Volume 171, Number 4, February 2005, 348-353
A more recent version of this article appeared on February 15, 2005
Submitted on May 17, 2004
Accepted on October 26, 2004
Cumulative Influence of Organ Dysfunctions and Septic State on Mortality of Critically Ill Children
Francis Leclerc1*, Stephane Leteurtre1, Alain Duhamel2, Bruno Grandbastien3, Francois Proulx4, Alain Martinot1, France Gauvin4, Philippe Hubert5, and Jacques Lacroix4
1 Pediatric Intensive Care Unit, Jeanne de Flandre University Hospital, Lille, France,
2 Department of Biostatistics, CERIM, Faculty of Medicine, Universite de Lille, Lille, France,
3 Department of Epidemiology and Public Health, Calmette University Hospital, Lille, France,
4 Pediatric Intensive Care Unit, Sainte-Justine Hospital, Universite de Montreal, Montreal, Quebec, Canada,
5 Pediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, Paris, France
* To whom correspondence should be addressed. E-mail: fleclerc{at}chru-lille.fr.
The interaction between sepsis and multiple organ dysfunction syndrome is poorly defined in children. We analyzed by Cox regression models the cumulative influence of organ dysfunctions, using the PELOD score, and septic state [systemic inflammatory response syndrome or sepsis, severe sepsis and septic shock] on mortality of critically ill children. We included 593 children (mortality rate: 8.6%) from three pediatric intensive care units; 514 patients had at least a systemic inflammatory response syndrome and 269 had 2 or more organ dysfunctions. Hazard ratio of death significantly increased with the severity of organ dysfunction, as estimated by the PELOD score, and the worst diagnostic category of septic state. Each increase of one unit in the PELOD score multiplied the hazard ratio by 1.096 (p <0.0001); hazard ratio of diagnostic category was 9.039 (p=0.031) for systemic inflammatory response syndrome or sepsis, 18.797 (p=0.007) for severe sepsis and 32.572 (p<0.001) for septic shock [cumulative hazard ratio of death = (hazard ratio of PELOD score) x (hazard ratio of diagnostic category]. We conclude that there is a cumulative accrual of the risk of death both with an increasing severity of organ dysfunctions and an increasing severity of the diagnostic category of septic state.
Key words: sepsis, septic shock, multiple organ dysfunction syndrome, child, critical care
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