title: Clinical outcomes after utilizing surviving sepsis campaign in children with septic shock and prognostic value of initial plasma NT-proBNP.
abstract: OBJECTIVE
  The surviving sepsis campaign treatment guideline (SSC) implementation is associated with improved outcome in adults with severe sepsis. The effect on outcome of pediatric sepsis is less clear.
  
  
  OBJECTIVE
  To determine the clinical outcomes of SSC implementation and to investigate the prognostic value of initial plasma NT-proBNP and procalcitonin in children.
  
  
  METHODS
  Infants and children (aged 1month/0-15 years with severe sepsis or septic shock) were prospectively enrolled and treated according to the guidelines. Initial blood drawn was saved for NT-pro-BNP, procalcitonin measurements and clinical data were also recorded.
  
  
  RESULTS
  A total of 47 subjects were recruited. Since the application of the SSC, our mortality rate had significantly decreased from 42-19% (P = 0.003) as compared to the data in the previous 3 years. Clinical factors that significantly increased the mortality rate were: Initial central venous oxygen saturation < 7 0% after fluid resuscitation [odds ratio (OR) = 23.3; 95% confidence interval (CI) 3.7-143; P = 0.001], and initial albumin level (≤ 3 g/dl, OR = 6.7; 95% CI 1.2-37.5, P = 0.03). There was asignificant difference between the initial NT-proBNP levels between survivors and non survivors, (6280.3 ± 9597 ng/L, P < 0.001), but not for procalcitonin (12.7 ± 24.8, 29.3 ± 46 μg/L, P = 0.1), respectively. An initial NT-proBNP level of more than 11,200 pg/ml predicted Pediatric Intensive Care Unit (PICU) mortality with a sensitivity of 85.7% and a specificity of 90%.
  
  
  CONCLUSIONS
  A modified SSC for severe sepsis and septic shock significantly reduced the mortality rate in our PICU. High initial NT-ProBNP level was associated with mortality.
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Rujipat
authors.initials: R
authors.lastname: Samransamruajkit
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Rattapon
authors.initials: R
authors.lastname: Uppala
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Khemmachart
authors.initials: K
authors.lastname: Pongsanon
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Jitladda
authors.initials: J
authors.lastname: Deelodejanawong
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Suchada
authors.initials: S
authors.lastname: Sritippayawan
authors.affiliation: Department of Pediatrics, Division of Pediatric Pulmonary and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Nuanchan
authors.initials: N
authors.lastname: Prapphal
keywords: Biomarker; SSC guideline; decrease mortality; mortality; pediatric sepsis; severe sepsis; surviving sepsis campaign