Epidemiology of sepsis and multiple organ dysfunction syndrome in children.
OBJECTIVE
To determine the cumulated incidence and the density of incidence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS) in critically ill children; to distinguish patients with primary from those with secondary MODS.


METHODS
Prospective cohort study.


METHODS
Pediatric ICU of a university hospital.


METHODS
One thousand fifty-eight consecutive hospital admissions.


METHODS
None.


RESULTS
SIRS occurred in 82% (n=869) of hospital admissions, 23% (n=245) had sepsis, 4% (n=46) had severe sepsis, 2% (n=25) had septic shock; 16% (n=168) had primary MODS and 2% (n=23) had secondary MODS; 6% (n=68) of the study population died. The pediatric risk of mortality (PRISM) scores on the first day of admission to pediatric ICU were as follows: 3.9 +/- 3.6 (no SIRS), 7.0 +/- 7.0 (SIRS), 9.5 +/- 8.3 (sepsis), 8.8 +/- 7.8 (severe sepsis), 21.8 +/- 15.8 (septic shock); differences among groups (p=0.0001), all orthogonal comparisons, were significant (p<0.05), except for patients with severe sepsis. The observed mortality for the whole study population was also different according to the underlying diagnostic category (p=0.0001; p<0.05 for patients with SIRS and those with septic shock, compared with all groups). Among, patients with MODS, the difference in mortality between groups did not reach significance (p=0.057). Children with secondary MODS had a longer duration of organ dysfunction (p<0.0001), a longer stay in pediatric ICU after MODS diagnosis (p<0.0001), and a higher risk of mortality (odds ratio, 6.5 [2.7 to 15.9], p<0.0001) than patients with primary MODS.


CONCLUSIONS
SIRS and sepsis occur frequently in critically ill children. The presence of SIRS, sepsis, or septic shock is associated with a distinct risk of mortality among critically ill children admitted to the pediatric ICU; more data are needed concerning children with MODS. Secondary MODS is much less common than primary MODS, but it is associated with an increased morbidity and mortality; we speculate that distinct pathophysiologic mechanisms are involved in these two conditions.
Proulx
F
F
Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Canada.
Fayon
M
M
Farrell
C A
CA
Lacroix
J
J
Gauthier
M
M
D000293:Adolescent; D001424:Bacterial Infections / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000401:mortality