Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit |
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| Authors: | J D Wilkinson M M Pollack N L Glass R K Kanter R W Katz C M Steinhart |
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| Affiliation: | 1. Department of Pediatrics, The New York Hospital-Cornell Medical Center, New York, USA;2. Departments of Anesthesiology (Division of Critical Care Pediatrics) and Child Health and Development, George Washington University School of Medicine and Health Sciences, Washington, D.C. USA;3. Departments of Pediatrics, The University of Texas Health Science Center at Houston, State University of New York Health Sciences Center at Syracuse. The University of New Mexico School of Medicine, Albuquerque, USA;4. Medical College of Georgia, Augusta USA;1. Department of Radiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;2. Department of Paediatrics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;3. Department of Paediatric Clinical Physiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;4. Department of Radiation Physics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;1. Department of Biochemistry and Molecular Biology, Harbin Medical University Harbin, China;2. Translational Medicine Center of Northern China, Harbin, China;3. Basic Medical Institute of Heilongjiang Medical Science Academy, Harbin, China;4. Division of Cardiology, the First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, China;5. Yamagata Universities, Japan;1. Division of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI;2. Medical Intensive Care Unit, Rhode Island Hospital, Providence, RI;3. Anaesthesia and Intensive Care Medicine, St George''s University Hospitals NHS Foundation Trust, London, UK;4. Medicine, NYU School of Medicine, New York, NY;1. Helmholtz Centre for Environmental Research – UFZ, Leipzig, Germany;2. TU Dresden, Germany;3. Leipzig University of Applied Sciences, Germany |
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| Abstract: | Seven hundred twenty-six patients from five pediatric intensive care units were studied to determine the association of multiple organ system failure (MOSF) with mortality and to test the hypothesis that MOSF associated with sepsis has a higher mortality rate than MOSF without sepsis. There were 177 (24%) patients with MOSF and 83 (11%) nonsurvivors of MOSF. The mortality rates for two, three, or four or more failed organ systems were 26%, 62%, and 88%, respectively (P less than 0.001). Eighty-four (47%) patients with MOSF had associated sepsis. Sepsis (both bacteremia and clinical sepsis syndrome) did not significantly increase mortality rates in the groups with organ system failure. Mortality rates for patients with sepsis before or within 24 hours of development of MOSF (early sepsis) did not differ from mortality rates for those patients with onset of sepsis more than 24 hours after developing MOSF (late sepsis, 53% vs 33%, P = NS). We conclude that underlying pathophysiologic mechanisms of MOSF other than sepsis are as important as sepsis in critically ill pediatric patients. |
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