New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality

John C. Lin, Philip C. Spinella, Julie C. Fitzgerald, Marisa Tucci, Jenny L. Bush, Vinay M. Nadkarni, Neal J. Thomas, Scott L. Weiss, P. Fontela, M. Tucci, M. Dumistrascu, P. Skippen, G. Krahn, E. Bezares, G. Puig, A. Puig-Ramos, R. Garcia, M. Villar, M. Bigham, T. PolanskiS. Latifi, D. Giebner, H. Anthony, J. Hume, A. Galster, L. Linnerud, R. Sanders, G. Hefley, K. Madden, A. Thompson, S. Shein, S. Gertz, Y. Han, T. Williams, A. Hughes-Schalk, H. Chandler, A. Orioles, E. Zielinski, A. Doucette, A. Orioles, E. Zielinski, A. Doucette, C. Zebuhr, T. Wilson, C. Dimitriades, J. Ascani, S. Layburn, S. Valley, B. Markowitz, J. Terry, Sepsis Prevalence, Outcomes, and Therapy Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network

Research output: Contribution to journalArticle

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Abstract

Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.

Original languageEnglish (US)
Pages (from-to)8-16
Number of pages9
JournalPediatric Critical Care Medicine
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2017

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Multiple Organ Failure
Sepsis
Pediatrics
Morbidity
Phenotype
Mortality
Hospital Mortality

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Lin, J. C., Spinella, P. C., Fitzgerald, J. C., Tucci, M., Bush, J. L., Nadkarni, V. M., ... Sepsis Prevalence, Outcomes, and Therapy Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network (2017). New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality. Pediatric Critical Care Medicine, 18(1), 8-16. https://doi.org/10.1097/PCC.0000000000000978
Lin, John C. ; Spinella, Philip C. ; Fitzgerald, Julie C. ; Tucci, Marisa ; Bush, Jenny L. ; Nadkarni, Vinay M. ; Thomas, Neal J. ; Weiss, Scott L. ; Fontela, P. ; Tucci, M. ; Dumistrascu, M. ; Skippen, P. ; Krahn, G. ; Bezares, E. ; Puig, G. ; Puig-Ramos, A. ; Garcia, R. ; Villar, M. ; Bigham, M. ; Polanski, T. ; Latifi, S. ; Giebner, D. ; Anthony, H. ; Hume, J. ; Galster, A. ; Linnerud, L. ; Sanders, R. ; Hefley, G. ; Madden, K. ; Thompson, A. ; Shein, S. ; Gertz, S. ; Han, Y. ; Williams, T. ; Hughes-Schalk, A. ; Chandler, H. ; Orioles, A. ; Zielinski, E. ; Doucette, A. ; Orioles, A. ; Zielinski, E. ; Doucette, A. ; Zebuhr, C. ; Wilson, T. ; Dimitriades, C. ; Ascani, J. ; Layburn, S. ; Valley, S. ; Markowitz, B. ; Terry, J. ; Sepsis Prevalence, Outcomes, and Therapy Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. / New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis : A Sepsis Phenotype With Higher Morbidity and Mortality. In: Pediatric Critical Care Medicine. 2017 ; Vol. 18, No. 1. pp. 8-16.
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title = "New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality",
abstract = "Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68{\%}) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26{\%}. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51{\%} compared with patients with new multiple organ dysfunction syndrome (28{\%}) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10{\%}) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22{\%} versus 29{\%} versus 11{\%} for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26{\%}) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.",
author = "Lin, {John C.} and Spinella, {Philip C.} and Fitzgerald, {Julie C.} and Marisa Tucci and Bush, {Jenny L.} and Nadkarni, {Vinay M.} and Thomas, {Neal J.} and Weiss, {Scott L.} and P. Fontela and M. Tucci and M. Dumistrascu and P. Skippen and G. Krahn and E. Bezares and G. Puig and A. Puig-Ramos and R. Garcia and M. Villar and M. Bigham and T. Polanski and S. Latifi and D. Giebner and H. Anthony and J. Hume and A. Galster and L. Linnerud and R. Sanders and G. Hefley and K. Madden and A. Thompson and S. Shein and S. Gertz and Y. Han and T. Williams and A. Hughes-Schalk and H. Chandler and A. Orioles and E. Zielinski and A. Doucette and A. Orioles and E. Zielinski and A. Doucette and C. Zebuhr and T. Wilson and C. Dimitriades and J. Ascani and S. Layburn and S. Valley and B. Markowitz and J. Terry and {Sepsis Prevalence, Outcomes, and Therapy Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network}",
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Lin, JC, Spinella, PC, Fitzgerald, JC, Tucci, M, Bush, JL, Nadkarni, VM, Thomas, NJ, Weiss, SL, Fontela, P, Tucci, M, Dumistrascu, M, Skippen, P, Krahn, G, Bezares, E, Puig, G, Puig-Ramos, A, Garcia, R, Villar, M, Bigham, M, Polanski, T, Latifi, S, Giebner, D, Anthony, H, Hume, J, Galster, A, Linnerud, L, Sanders, R, Hefley, G, Madden, K, Thompson, A, Shein, S, Gertz, S, Han, Y, Williams, T, Hughes-Schalk, A, Chandler, H, Orioles, A, Zielinski, E, Doucette, A, Orioles, A, Zielinski, E, Doucette, A, Zebuhr, C, Wilson, T, Dimitriades, C, Ascani, J, Layburn, S, Valley, S, Markowitz, B, Terry, J & Sepsis Prevalence, Outcomes, and Therapy Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network 2017, 'New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality', Pediatric Critical Care Medicine, vol. 18, no. 1, pp. 8-16. https://doi.org/10.1097/PCC.0000000000000978

New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis : A Sepsis Phenotype With Higher Morbidity and Mortality. / Lin, John C.; Spinella, Philip C.; Fitzgerald, Julie C.; Tucci, Marisa; Bush, Jenny L.; Nadkarni, Vinay M.; Thomas, Neal J.; Weiss, Scott L.; Fontela, P.; Tucci, M.; Dumistrascu, M.; Skippen, P.; Krahn, G.; Bezares, E.; Puig, G.; Puig-Ramos, A.; Garcia, R.; Villar, M.; Bigham, M.; Polanski, T.; Latifi, S.; Giebner, D.; Anthony, H.; Hume, J.; Galster, A.; Linnerud, L.; Sanders, R.; Hefley, G.; Madden, K.; Thompson, A.; Shein, S.; Gertz, S.; Han, Y.; Williams, T.; Hughes-Schalk, A.; Chandler, H.; Orioles, A.; Zielinski, E.; Doucette, A.; Orioles, A.; Zielinski, E.; Doucette, A.; Zebuhr, C.; Wilson, T.; Dimitriades, C.; Ascani, J.; Layburn, S.; Valley, S.; Markowitz, B.; Terry, J.; Sepsis Prevalence, Outcomes, and Therapy Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network.

In: Pediatric Critical Care Medicine, Vol. 18, No. 1, 01.01.2017, p. 8-16.

Research output: Contribution to journalArticle

TY - JOUR

T1 - New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis

T2 - A Sepsis Phenotype With Higher Morbidity and Mortality

AU - Lin, John C.

AU - Spinella, Philip C.

AU - Fitzgerald, Julie C.

AU - Tucci, Marisa

AU - Bush, Jenny L.

AU - Nadkarni, Vinay M.

AU - Thomas, Neal J.

AU - Weiss, Scott L.

AU - Fontela, P.

AU - Tucci, M.

AU - Dumistrascu, M.

AU - Skippen, P.

AU - Krahn, G.

AU - Bezares, E.

AU - Puig, G.

AU - Puig-Ramos, A.

AU - Garcia, R.

AU - Villar, M.

AU - Bigham, M.

AU - Polanski, T.

AU - Latifi, S.

AU - Giebner, D.

AU - Anthony, H.

AU - Hume, J.

AU - Galster, A.

AU - Linnerud, L.

AU - Sanders, R.

AU - Hefley, G.

AU - Madden, K.

AU - Thompson, A.

AU - Shein, S.

AU - Gertz, S.

AU - Han, Y.

AU - Williams, T.

AU - Hughes-Schalk, A.

AU - Chandler, H.

AU - Orioles, A.

AU - Zielinski, E.

AU - Doucette, A.

AU - Orioles, A.

AU - Zielinski, E.

AU - Doucette, A.

AU - Zebuhr, C.

AU - Wilson, T.

AU - Dimitriades, C.

AU - Ascani, J.

AU - Layburn, S.

AU - Valley, S.

AU - Markowitz, B.

AU - Terry, J.

AU - Sepsis Prevalence, Outcomes, and Therapy Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.

AB - Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.

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U2 - 10.1097/PCC.0000000000000978

DO - 10.1097/PCC.0000000000000978

M3 - Article

C2 - 28060151

AN - SCOPUS:85008500770

VL - 18

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JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

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