title: Incidence and risk factors for mortality in paediatric severe sepsis: results from the national paediatric intensive care registry in Japan.
abstract: OBJECTIVE
  To assess the incidence, background, outcome and risk factors for death of severe sepsis in Japanese paediatric intensive care units (PICUs).
  
  
  METHODS
  A data analysis of a prospective, multicentre, 3-year case registry from nine medical-surgical Japanese PICUs. Children with severe sepsis, aged 0-15 years, who were consecutively admitted to the participating PICUs from 1 January 2007 to 31 December 2009 were enrolled. The incidence, background, causative pathogens or infective foci, outcome and risk factors for death caused by severe sepsis were analysed.
  
  
  RESULTS
  One hundred forty-one cases were registered. After the exclusion of 14 patients because of incomplete data or inappropriate entry, 127 patients were eligible for the analysis. There were 60 boys and 67 girls, aged 23 [5-68] (median [IQR]) months and weighed 10 [5.5-16.5] kg. The incidence was 1.4 % of total PICU admissions. Sepsis was community-acquired in 35 %, PICU-acquired in 37 % and acquired in hospital general wards in 28 %. Methicillin-resistant Staphylococcus aureus was the most frequent pathogen. The crude 28-day mortality was 18.9 %, comparable to the mean PIM-2 predicted mortality (17.7 %). The mortality rate in patients with shock was significantly increased to 28 % compared to those without shock (5 %). The presences of existing haematological disorders (OR 8.97, 95 % CI, 1.56-51.60) and shock (OR 5.35, 1.04-27.44) were significant factors associated with mortality by multivariate analysis.
  
  
  CONCLUSIONS
  The mortality from severe sepsis/septic shock in Japanese PICUs was ~19 %. Haematological disorders and presence of shock were associated with death.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan. shime@koto.kpu-m.ac.jp
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Shime
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kawasaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Saito
authors.forename: Yoko
authors.initials: Y
authors.lastname: Akamine
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Toda
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Hiroko
authors.initials: H
authors.lastname: Sugimura
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sakurai
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Iijima
authors.forename: Ikuya
authors.initials: I
authors.lastname: Ueta
authors.forename: Naoki
authors.initials: N
authors.lastname: Shimizu
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakagawa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000401:mortality; D003428:Cross Infection / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000382:microbiology / Q000401:mortality*