Cardiovascular Dysfunction as a Predictor of Mortality in Children With Septic Shock

Introduction : Cardiovascular dysfunction and septic cardiomyopathy are the main causes of mortality in children with septic shock. Objective: To investigate characteristics of the hemodynamic status of children with septic shock on day 1 of pediatric intensive care unit (PICU) stay, depending on the outcome. Materials and methods : Our single-center, retrospective and prospective observational study included a total of 55 children (age, 1 to 18 years) with septic shock. Sepsis was mainly caused by community-acquired pneumonia and peritonitis. We evaluated the cardiac index, systemic vascular resistance index (SVRI), modified shock index, levels of troponin I, creatine phosphokinase-MB, N-terminal pro–brain natriuretic peptide (NT-proBNP), and lactate, and characteristics of catecholamine support on day 1 of PICU stay. Results : Overall mortality was 21.8% (n = 12). In terms of the outcome, the most unfavorable combination ( Р = .00015) was high SVRI (>1411 dyn∙s/cm 5 /m 2 ) with low or even normal cardiac index (≤3.5 L/min/m 2 ). The NT-proBNP level above 3263 ng/L showed a high odds ratio (OR) and high likelihood of death (OR, 128.3; Р = .004). Vasopressor doses of dopamine above 5 mcg/ kg/min by the end of day 1 were associated with a high OR of death (OR, 71.5; P < .0001). There were no significant differences between fluid loading both in the first hour and on day 1 ( Р = .820 and Р = .211, respectively). Fluid balance on day 1 was comparable in both groups ( P = .970). Conclusions : Selective hemodynamic support to normalize the cardiac index (>3.5 L/min/m 2 ) and SVRI (800-1400 dyn∙s/cm 5 /m 2 ) is the key management factor that reduces mortality in children with septic shock.