Clinical profile, intensive care needs, outcome, and predictors of mortality in children with severe sepsis: Secondary analysis of FerriPedS study

Background and objectives Sepsis remains a leading cause of mortality among children worldwide. This study aimed to describe clinical profile, intensive care needs, outcome, and predictors of mortality among children with severe sepsis. Methods This secondary analysis of FerriPedS study was conducted in a tertiary pediatric intensive care units (PICU) in North India involving 115 children (3 months-12 yr) with severe sepsis. Data were collected regarding clinical details, laboratory investigations, organ dysfunction, intensive care needs, and outcome. Univariate and multinomial logistic regression analyses were used to determine predictors of mortality among severity score, organ dysfunction, serum ferritin, and PICU needs. Results The median (IQR) age was 3 (1-7) years, and common diagnoses were community acquired pneumonia (CAP) (n=45 39.1%), scrub typhus (n=16, 13.9%), and CNS infections (n=12,10.4%). Mortality was 27.8% (n=32). Non-survivors had significantly higher Pediatric Risk of Mortality-III (PRISM III) score, serum ferritin, and daily Pediatric logistic organ dysfunction-2 (PeLOD-2) score. Higher proportion of non-survivors had positive blood culture at admission, coagulopathy, hepatic dysfunction, shock, acute respiratory distress (ARDS), acute kidney injury (AKI), and multiple organ dysfunction score (MODS); and required invasive mechanical ventilation, vasoactive drugs, blood products, and RRT. On multinomial logistic regression analysis, PRISM-III, ARDS, and AKI were independent predictors of mortality. Interpretation and conclusions In children with severe sepsis, the common etiologies included CAP, scrub typhus, and CNS infections, and characterised by high mortality (27.8%). PRISM-III score, ARDS, and AKI were independent predictors of mortality.