title: Prediction of pediatric sepsis mortality within 1 h of intensive care admission.
abstract: OBJECTIVE
  The definitions of sepsis and septic shock have recently been revised in adults, but contemporary data are needed to inform similar approaches in children.
  
  
  METHODS
  Multicenter cohort study including children <16 years admitted with sepsis or septic shock to ICUs in Australia and New Zealand in the period 2012-2015. We assessed septic shock criteria at ICU admission to define sepsis severity, using 30-day mortality as outcome. Through multivariable logistic regression, a pediatric sepsis score was derived using variables available within 60 min of ICU admission.
  
  
  RESULTS
  Of 42,523 pediatric admissions, 4403 children were admitted with invasive infection, including 1697 diagnosed as having sepsis/septic shock on admission. Mortality was 8.5% (144/1697) and 50.7% of deaths occurred within 48 h of admission. The presence of septic shock as defined by the 2005 consensus was sensitive but not specific in predicting mortality (AUC = 0.69; 95% CI 0.65-0.72). Combinations of hypotension, vasopressor therapy, and lactate >2 mmol/l discriminated poorly (AUC <0.60). Multivariate models showed that oxygenation markers, ventilatory support, hypotension, cardiac arrest, serum lactate, pupil responsiveness, and immunosuppression were the best-performing predictors (0.843; 0.811-0.875). We derived a pediatric sepsis score (0.817; 0.779-0.855), and every one-point increase was associated with a 28.5% (23.8-33.2%) increase in the odds of death. Children with a score ≥6 had 19.8% mortality and accounted for 74.3% of deaths. The sepsis score performed comparably when applied to all children admitted with invasive infection (0.810; 0.781-0.840).
  
  
  CONCLUSIONS
  We observed mortality patterns specific to pediatric sepsis that support the need for specialized definitions of sepsis severity in children. We demonstrated the importance of lactate, cardiovascular, and respiratory derangements at ICU admission for the identification of children with substantially higher risk of sepsis mortality.
authors.affiliation: Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia. l.schlapbach@uq.edu.au.|Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia. l.schlapbach@uq.edu.au.|Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. l.schlapbach@uq.edu.au.
authors.forename: Luregn J
authors.initials: LJ
authors.lastname: Schlapbach
authors.affiliation: Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore.|Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Graeme
authors.initials: G
authors.lastname: MacLaren
authors.affiliation: Paediatric Intensive Care Unit, Children's Hospital Westmead, Sydney, Australia.
authors.forename: Marino
authors.initials: M
authors.lastname: Festa
authors.affiliation: The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), ANZICS House, Ievers Terrace, Carlton South, Melbourne, Australia.|School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Alexander
authors.affiliation: Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Erickson
authors.affiliation: Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Beca
authors.affiliation: Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Slater
authors.affiliation: Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia.|Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schibler
authors.affiliation: The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), ANZICS House, Ievers Terrace, Carlton South, Melbourne, Australia.|Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.|Department of Intensive Care, The Alfred Hospital, Commercial Road, Prahran, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Pilcher
authors.affiliation: Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Johnny
authors.initials: J
authors.lastname: Millar
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Lahn
authors.initials: L
authors.lastname: Straney
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000145:classification* / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: Childhood; Infection; Mortality; Sepsis; Septic shock