title: Epidemiology and outcome of sepsis in a tertiary care PICU of Pakistan.
abstract: OBJECTIVE
  To determine the epidemiology and outcome of sepsis in children admitted in pediatric intensive care unit (PICU) of a tertiary care hospital.
  
  
  METHODS
  Retrospective review of children 1 mo to 14 y old, admitted to the PICU with severe sepsis or septic shock from January 2007 through December 2008 was done. Demographic, clinical and laboratory features of subjects were reviewed. The primary outcome was mortality at the time of discharge from PICU. The independent predictors of mortality were modeled using multiple logistic regression.
  
  
  RESULTS
  In 2 years, 17.3% (133/767) children admitted to the PICU had sepsis. Median age was 18 mo (IQR 6-93 mo), with male: female ratio of 1.6:1. Mean PRISM III score was 9 (±7.8). One third had culture proven infection, majority (20%) having bloodstream infection. The frequency of multi-organ dysfunction syndrome (MODS) was 81% (108/133). The case specific mortality rate of sepsis was 24% (32/133). Multi-organ dysfunction (Adjusted OR 18.0, 95% CI 2.2-144), prism score of >10 (Adjusted OR 1.5, 95% CI 0.6-4.0) and the need for > 2 inotropes (Adjusted OR 3.5, 95% CI 1.3-9.2) were independently associated with mortality due to sepsis.
  
  
  CONCLUSIONS
  The presence of septic shock and MODS is associated with high mortality in the PICU of developing countries.
authors.affiliation: Department of Pediatrics and Child Health, University Hospital, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
authors.forename: Muhammad Rehan
authors.initials: MR
authors.lastname: Khan
authors.forename: Prem Kumar
authors.initials: PK
authors.lastname: Maheshwari
authors.forename: Komal
authors.initials: K
authors.lastname: Masood
authors.forename: Farah Naz
authors.initials: FN
authors.lastname: Qamar
authors.forename: Anwar-Ul
authors.initials: AU
authors.lastname: Haque
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003422:Critical Care; D003906:Developing Countries; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D010154:Pakistan; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome