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Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock.
Crit Care Med. 2020 03; 48(3):319-328.CC

Abstract

OBJECTIVES

A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes.

DESIGN

Prospective, cohort-outcome study, conducted 2013-2017.

SETTING

Twelve United States academic PICUs.

PATIENTS

Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.

INTERVENTIONS

Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale.

MEASUREMENTS AND MAIN RESULTS

In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3.

CONCLUSIONS AND RELEVANCE

Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock.

Authors+Show Affiliations

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.Division of Pediatric Critical Care Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Colorado, Denver, CO.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32058369

Citation

Zimmerman, Jerry J., et al. "Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock." Critical Care Medicine, vol. 48, no. 3, 2020, pp. 319-328.
Zimmerman JJ, Banks R, Berg RA, et al. Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. Crit Care Med. 2020;48(3):319-328.
Zimmerman, J. J., Banks, R., Berg, R. A., Zuppa, A., Newth, C. J., Wessel, D., Pollack, M. M., Meert, K. L., Hall, M. W., Quasney, M., Sapru, A., Carcillo, J. A., McQuillen, P. S., Mourani, P. M., Wong, H., Chima, R. S., Holubkov, R., Coleman, W., Sorenson, S., ... Reeder, R. W. (2020). Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. Critical Care Medicine, 48(3), 319-328. https://doi.org/10.1097/CCM.0000000000004122
Zimmerman JJ, et al. Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. Crit Care Med. 2020;48(3):319-328. PubMed PMID: 32058369.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. AU - Zimmerman,Jerry J, AU - Banks,Russell, AU - Berg,Robert A, AU - Zuppa,Athena, AU - Newth,Christopher J, AU - Wessel,David, AU - Pollack,Murray M, AU - Meert,Kathleen L, AU - Hall,Mark W, AU - Quasney,Michael, AU - Sapru,Anil, AU - Carcillo,Joseph A, AU - McQuillen,Patrick S, AU - Mourani,Peter M, AU - Wong,Hector, AU - Chima,Ranjit S, AU - Holubkov,Richard, AU - Coleman,Whitney, AU - Sorenson,Samuel, AU - Varni,James W, AU - McGalliard,Julie, AU - Haaland,Wren, AU - Whitlock,Kathryn, AU - Dean,J Michael, AU - Reeder,Ron W, AU - ,, PY - 2020/2/15/entrez PY - 2020/2/15/pubmed PY - 2020/10/24/medline SP - 319 EP - 328 JF - Critical care medicine JO - Crit Care Med VL - 48 IS - 3 N2 - OBJECTIVES: A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes. DESIGN: Prospective, cohort-outcome study, conducted 2013-2017. SETTING: Twelve United States academic PICUs. PATIENTS: Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support. INTERVENTIONS: Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale. MEASUREMENTS AND MAIN RESULTS: In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3. CONCLUSIONS AND RELEVANCE: Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/32058369/Critical_Illness_Factors_Associated_With_Long_Term_Mortality_and_Health_Related_Quality_of_Life_Morbidity_Following_Community_Acquired_Pediatric_Septic_Shock_ L2 - https://dx.doi.org/10.1097/CCM.0000000000004122 DB - PRIME DP - Unbound Medicine ER -