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Body Habitus and Risk of Mortality in Pediatric Sepsis and Septic Shock: A Retrospective Cohort Study.
J Pediatr. 2019 07; 210:178-183.e2.JPed

Abstract

OBJECTIVE

To investigate the association between body habitus and mortality in critically ill children with sepsis or septic shock.

STUDY DESIGN

This was a retrospective cohort study of prospectively collected data of children admitted to US pediatric intensive care units (PICUs) with a primary or secondary diagnosis of sepsis or septic shock. We separated body habitus into underweight, normal weight, overweight, and obese. Outcomes were mortality (primary), treatment with invasive mechanical ventilation (secondary), and time to PICU discharge for survivors (secondary). Multivariable analyses using mixed-effects logistic regression and shared frailty models clustered by unit and adjusted for confounding variables were used to assess the association between body habitus and outcomes.

RESULTS

There were 7038 children with sepsis or septic shock. Mortality was 10.1% (n = 714) and 52.9% (n = 3720) required invasive mechanical ventilation. Body habitus was not associated with mortality after controlling for hospital level effects and confounding variables. Children who were overweight and obese had greater odds of invasive mechanical ventilation (overweight OR 1.23 [95% CI 1.05-1.45], P = .011 and obese OR 1.57 [95% CI 1.37-1.80], P < .001) compared with children of normal weight. In survivors treated with invasive mechanical ventilation, children who were obese had a longer time to PICU discharge than children of normal weight (obese hazard ratio for discharge 0.84 [95% CI, 0.77-0.92], P < .0001).

CONCLUSIONS

There was no association between body habitus and mortality in critically ill children with sepsis. Children who were overweight and obese were more likely to receive invasive mechanical ventilation and mechanically ventilated survivors who were obsese had a longer time to PICU discharge.

Authors+Show Affiliations

Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: paross@chla.usc.edu.Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.Department of Pediatrics, Miller Children's and Women's Hospital of Long Beach, Long Beach, CA.Department of Pediatrics, University of North Carolina Healthcare Children's Hospital, Chapel Hill, NC.Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA.Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA.Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31036411

Citation

Ross, Patrick A., et al. "Body Habitus and Risk of Mortality in Pediatric Sepsis and Septic Shock: a Retrospective Cohort Study." The Journal of Pediatrics, vol. 210, 2019, pp. 178-183.e2.
Ross PA, Klein MJ, Nguyen T, et al. Body Habitus and Risk of Mortality in Pediatric Sepsis and Septic Shock: A Retrospective Cohort Study. J Pediatr. 2019;210:178-183.e2.
Ross, P. A., Klein, M. J., Nguyen, T., Leung, D., Khemani, R. G., Newth, C. J. L., & Bhalla, A. K. (2019). Body Habitus and Risk of Mortality in Pediatric Sepsis and Septic Shock: A Retrospective Cohort Study. The Journal of Pediatrics, 210, 178-e2. https://doi.org/10.1016/j.jpeds.2019.03.027
Ross PA, et al. Body Habitus and Risk of Mortality in Pediatric Sepsis and Septic Shock: a Retrospective Cohort Study. J Pediatr. 2019;210:178-183.e2. PubMed PMID: 31036411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Body Habitus and Risk of Mortality in Pediatric Sepsis and Septic Shock: A Retrospective Cohort Study. AU - Ross,Patrick A, AU - Klein,Margaret J, AU - Nguyen,Tuan, AU - Leung,Dennis, AU - Khemani,Robinder G, AU - Newth,Christopher J L, AU - Bhalla,Anoopindar K, Y1 - 2019/04/26/ PY - 2019/01/10/received PY - 2019/03/18/revised PY - 2019/03/18/accepted PY - 2019/5/1/pubmed PY - 2020/4/14/medline PY - 2019/5/1/entrez KW - body habitus KW - intensive care KW - mortality KW - pediatrics KW - sepsis KW - septic shock SP - 178 EP - 183.e2 JF - The Journal of pediatrics JO - J Pediatr VL - 210 N2 - OBJECTIVE: To investigate the association between body habitus and mortality in critically ill children with sepsis or septic shock. STUDY DESIGN: This was a retrospective cohort study of prospectively collected data of children admitted to US pediatric intensive care units (PICUs) with a primary or secondary diagnosis of sepsis or septic shock. We separated body habitus into underweight, normal weight, overweight, and obese. Outcomes were mortality (primary), treatment with invasive mechanical ventilation (secondary), and time to PICU discharge for survivors (secondary). Multivariable analyses using mixed-effects logistic regression and shared frailty models clustered by unit and adjusted for confounding variables were used to assess the association between body habitus and outcomes. RESULTS: There were 7038 children with sepsis or septic shock. Mortality was 10.1% (n = 714) and 52.9% (n = 3720) required invasive mechanical ventilation. Body habitus was not associated with mortality after controlling for hospital level effects and confounding variables. Children who were overweight and obese had greater odds of invasive mechanical ventilation (overweight OR 1.23 [95% CI 1.05-1.45], P = .011 and obese OR 1.57 [95% CI 1.37-1.80], P < .001) compared with children of normal weight. In survivors treated with invasive mechanical ventilation, children who were obese had a longer time to PICU discharge than children of normal weight (obese hazard ratio for discharge 0.84 [95% CI, 0.77-0.92], P < .0001). CONCLUSIONS: There was no association between body habitus and mortality in critically ill children with sepsis. Children who were overweight and obese were more likely to receive invasive mechanical ventilation and mechanically ventilated survivors who were obsese had a longer time to PICU discharge. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/31036411/Body_Habitus_and_Risk_of_Mortality_in_Pediatric_Sepsis_and_Septic_Shock:_A_Retrospective_Cohort_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(19)30346-4 DB - PRIME DP - Unbound Medicine ER -