Quality-of-Life Morbidity Common Among Children Who Survive Septic Shock
By Nancy Melville
ORLANDO, Fla -- February 21, 2020 -- Whereas the in-hospital risk of mortality associated with paediatric septic shock has plummeted in recent decades, many patients have not returned to baseline quality of life a year later, and many have substantial deterioration in health-related quality of life, according to a study presented here at the 2020 Annual Meeting of the Society of Critical Care Medicine (SCCM).
“This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality-life morbidity among children encountering community-acquired septic shock,” reported Jerry J. Zimmerman, MD, Seattle Children’s Hospital, Seattle, Washington, and colleagues.
“Survival no longer expresses the complete impact for children encountering sepsis,” said Dr. Zimmerman.
Mortality rates in the paediatric septic shock population have declined substantially in developed nations, from as high as 50% to 60% in the 1950s/1960s to as low as 5% to 10%. However, the long-term mortality and morbidity among children who survive has not been well documented.
To look into outcomes, a large team of investigators with the Life After Pediatric Sepsis Evaluation (LAPSE) study analysed data on 389 children (mean age, 7.4 years; 46% girls) who were critically ill with community-acquired septic shock requiring vasoactive-inotropic support between 2013 and 2017 at 12 academic paediatric intensive care units (PICUs) in the United States.
As assessed by the Pediatric Medical Complexity Algorithm, 18% of the children studied were immunocompromised, and 51% had chronic comorbidities. The Pediatric Overall Performance Category at baseline was normal in 38% of the children.
On PICU admission, the median Pediatric Risk of Mortality score was 11.0 (range, 6.0-17.0), and the median Pediatric Logistic Organ Dysfunction score was 9.0 (range, 6.0-11.0).
Patients had a median duration of vasoactive-inotropic support of 3.0 days (range, 2.0-6.0 days) and mechanical ventilation support of 8.0 days (range, 5.0-14.0 days).
The median duration of PICU stay was 9.4 days (range, 5.6-15.4 days) and of hospital stay was 15.7 days (range, 9.2-26.0 days).
Mortality rates at 1, 3, 6, and 12 months after PICU admission for septic shock were 8%, 11%, 12%, and 13%, respectively.
At 1 month, as many as 50% of patients who survived had not regained their baseline health-related quality of life; the rate was 37% at 3 months, 30% at 6 months, and 35% at 1 year.
“After 1 year, 35% of children surviving septic shock demonstrate clinically significant deterioration in health-related quality of life that persists at least a year after PICU admission for the sepsis event,” said Dr. Zimmerman.
“Collectively, this study demonstrates substantial health related quality of life morbidity among many critically ill children surviving septic shock,” concluded the researchers.
Dr. Zimmerman noted that “for children to ultimately thrive after sepsis, clinicians and investigators alike will need to additionally focus on interventions to facilitate return to baseline functional status and health-related quality of life.”
The study was published concurrently in Critical Care Medicine (Zimmerman J et al. 2020;48:329-337. doi: 10.1097/CCM.0000000000004123).
[Presentation title: Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock]
ORLANDO, Fla -- February 21, 2020 -- Whereas the in-hospital risk of mortality associated with paediatric septic shock has plummeted in recent decades, many patients have not returned to baseline quality of life a year later, and many have substantial deterioration in health-related quality of life, according to a study presented here at the 2020 Annual Meeting of the Society of Critical Care Medicine (SCCM).
“This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality-life morbidity among children encountering community-acquired septic shock,” reported Jerry J. Zimmerman, MD, Seattle Children’s Hospital, Seattle, Washington, and colleagues.
“Survival no longer expresses the complete impact for children encountering sepsis,” said Dr. Zimmerman.
Mortality rates in the paediatric septic shock population have declined substantially in developed nations, from as high as 50% to 60% in the 1950s/1960s to as low as 5% to 10%. However, the long-term mortality and morbidity among children who survive has not been well documented.
To look into outcomes, a large team of investigators with the Life After Pediatric Sepsis Evaluation (LAPSE) study analysed data on 389 children (mean age, 7.4 years; 46% girls) who were critically ill with community-acquired septic shock requiring vasoactive-inotropic support between 2013 and 2017 at 12 academic paediatric intensive care units (PICUs) in the United States.
As assessed by the Pediatric Medical Complexity Algorithm, 18% of the children studied were immunocompromised, and 51% had chronic comorbidities. The Pediatric Overall Performance Category at baseline was normal in 38% of the children.
On PICU admission, the median Pediatric Risk of Mortality score was 11.0 (range, 6.0-17.0), and the median Pediatric Logistic Organ Dysfunction score was 9.0 (range, 6.0-11.0).
Patients had a median duration of vasoactive-inotropic support of 3.0 days (range, 2.0-6.0 days) and mechanical ventilation support of 8.0 days (range, 5.0-14.0 days).
The median duration of PICU stay was 9.4 days (range, 5.6-15.4 days) and of hospital stay was 15.7 days (range, 9.2-26.0 days).
Mortality rates at 1, 3, 6, and 12 months after PICU admission for septic shock were 8%, 11%, 12%, and 13%, respectively.
At 1 month, as many as 50% of patients who survived had not regained their baseline health-related quality of life; the rate was 37% at 3 months, 30% at 6 months, and 35% at 1 year.
“After 1 year, 35% of children surviving septic shock demonstrate clinically significant deterioration in health-related quality of life that persists at least a year after PICU admission for the sepsis event,” said Dr. Zimmerman.
“Collectively, this study demonstrates substantial health related quality of life morbidity among many critically ill children surviving septic shock,” concluded the researchers.
Dr. Zimmerman noted that “for children to ultimately thrive after sepsis, clinicians and investigators alike will need to additionally focus on interventions to facilitate return to baseline functional status and health-related quality of life.”
The study was published concurrently in Critical Care Medicine (Zimmerman J et al. 2020;48:329-337. doi: 10.1097/CCM.0000000000004123).
[Presentation title: Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock]
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