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Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis.
JAMA Pediatr. 2019 04 01; 173(4):352-362.JP

Abstract

Importance

The global patterns and distribution of case-fatality rates (CFRs) in pediatric severe sepsis and septic shock remain poorly described.

Objective

We performed a systematic review and meta-analysis of studies of children with severe sepsis and septic shock to elucidate the patterns of CFRs in developing and developed countries over time. We also described factors associated with CFRs.

Data Sources

We searched PubMed, Web of Science, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central systematically for randomized clinical trials and prospective observational studies from earliest publication until January 2017, using the keywords "pediatric," "sepsis," "septic shock," and "mortality."

Study Selection

Studies involving children with severe sepsis and septic shock that reported CFRs were included. Retrospective studies and studies including only neonates were excluded.

Data Extraction and Synthesis

We conducted our systematic review and meta-analysis in close accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled case-fatality estimates were obtained using random-effects meta-analysis. The associations of study period, study design, sepsis severity, age, and continents in which studies occurred were assessed with meta-regression.

Main Outcomes and Measures

Meta-analyses to provide pooled estimates of CFR of pediatric severe sepsis and septic shock over time.

Results

Ninety-four studies that included 7561 patients were included. Pooled CFRs were higher in developing countries (31.7% [95% CI, 27.3%-36.4%]) than in developed countries (19.3% [95% CI, 16.4%-22.7%]; P < .001). Meta-analysis of CFRs also showed significant heterogeneity across studies. Continents that include mainly developing countries reported higher CFRs (adjusted odds ratios: Africa, 7.89 [95% CI, 6.02-10.32]; P < .001; Asia, 3.81 [95% CI, 3.60-4.03]; P < .001; South America, 2.91 [95% CI, 2.71-3.12]; P < .001) than North America. Septic shock was associated with higher CFRs than severe sepsis (adjusted odds ratios, 1.47 [95% CI, 1.41-1.54]). Younger age was also a risk factor (adjusted odds ratio, 0.95 [95% CI, 0.94-0.96] per year of increase in age). Earlier study eras were associated with higher CFRs (adjusted odds ratios for 1991-2000, 1.24 [95% CI, 1.13-1.37]; P < .001) compared with 2011 to 2016. Time-trend analysis showed higher CFRs over time in developing countries than developed countries.

Conclusions and Relevance

Despite the declining trend of pediatric severe sepsis and septic shock CFRs, the disparity between developing and developed countries persists. Further characterizations of vulnerable populations and collaborations between developed and developing countries are warranted to reduce the burden of pediatric sepsis globally.

Authors+Show Affiliations

Duke-NUS Medical School, Singapore.Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.Duke-NUS Medical School, Singapore.Department of Pediatrics, KK Women's and Children's Hospital, Singapore.London School of Hygiene and Tropical Medicine, London, United Kingdom.Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.Duke-NUS Medical School, Singapore. Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

30742207

Citation

Tan, Bobby, et al. "Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: a Systematic Review and Meta-analysis." JAMA Pediatrics, vol. 173, no. 4, 2019, pp. 352-362.
Tan B, Wong JJ, Sultana R, et al. Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(4):352-362.
Tan, B., Wong, J. J., Sultana, R., Koh, J. C. J. W., Jit, M., Mok, Y. H., & Lee, J. H. (2019). Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. JAMA Pediatrics, 173(4), 352-362. https://doi.org/10.1001/jamapediatrics.2018.4839
Tan B, et al. Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: a Systematic Review and Meta-analysis. JAMA Pediatr. 2019 04 1;173(4):352-362. PubMed PMID: 30742207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. AU - Tan,Bobby, AU - Wong,Judith Ju-Ming, AU - Sultana,Rehena, AU - Koh,Janine Cynthia Jia Wen, AU - Jit,Mark, AU - Mok,Yee Hui, AU - Lee,Jan Hau, PY - 2019/2/12/pubmed PY - 2020/2/23/medline PY - 2019/2/12/entrez SP - 352 EP - 362 JF - JAMA pediatrics JO - JAMA Pediatr VL - 173 IS - 4 N2 - Importance: The global patterns and distribution of case-fatality rates (CFRs) in pediatric severe sepsis and septic shock remain poorly described. Objective: We performed a systematic review and meta-analysis of studies of children with severe sepsis and septic shock to elucidate the patterns of CFRs in developing and developed countries over time. We also described factors associated with CFRs. Data Sources: We searched PubMed, Web of Science, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central systematically for randomized clinical trials and prospective observational studies from earliest publication until January 2017, using the keywords "pediatric," "sepsis," "septic shock," and "mortality." Study Selection: Studies involving children with severe sepsis and septic shock that reported CFRs were included. Retrospective studies and studies including only neonates were excluded. Data Extraction and Synthesis: We conducted our systematic review and meta-analysis in close accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled case-fatality estimates were obtained using random-effects meta-analysis. The associations of study period, study design, sepsis severity, age, and continents in which studies occurred were assessed with meta-regression. Main Outcomes and Measures: Meta-analyses to provide pooled estimates of CFR of pediatric severe sepsis and septic shock over time. Results: Ninety-four studies that included 7561 patients were included. Pooled CFRs were higher in developing countries (31.7% [95% CI, 27.3%-36.4%]) than in developed countries (19.3% [95% CI, 16.4%-22.7%]; P < .001). Meta-analysis of CFRs also showed significant heterogeneity across studies. Continents that include mainly developing countries reported higher CFRs (adjusted odds ratios: Africa, 7.89 [95% CI, 6.02-10.32]; P < .001; Asia, 3.81 [95% CI, 3.60-4.03]; P < .001; South America, 2.91 [95% CI, 2.71-3.12]; P < .001) than North America. Septic shock was associated with higher CFRs than severe sepsis (adjusted odds ratios, 1.47 [95% CI, 1.41-1.54]). Younger age was also a risk factor (adjusted odds ratio, 0.95 [95% CI, 0.94-0.96] per year of increase in age). Earlier study eras were associated with higher CFRs (adjusted odds ratios for 1991-2000, 1.24 [95% CI, 1.13-1.37]; P < .001) compared with 2011 to 2016. Time-trend analysis showed higher CFRs over time in developing countries than developed countries. Conclusions and Relevance: Despite the declining trend of pediatric severe sepsis and septic shock CFRs, the disparity between developing and developed countries persists. Further characterizations of vulnerable populations and collaborations between developed and developing countries are warranted to reduce the burden of pediatric sepsis globally. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/30742207/Global_Case_Fatality_Rates_in_Pediatric_Severe_Sepsis_and_Septic_Shock:_A_Systematic_Review_and_Meta_analysis_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.4839 DB - PRIME DP - Unbound Medicine ER -