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Biomarkers for Estimating Risk of Hospital Mortality and Long-Term Quality-of-Life Morbidity After Surviving Pediatric Septic Shock: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation Investigation.
Pediatr Crit Care Med. 2021 01 01; 22(1):8-15.PC

Abstract

OBJECTIVES

The Life After Pediatric Sepsis Evaluation investigation recently reported that one-third of children who survive sepsis experience significant health-related quality-of-life impairment compared with baseline at 1 year after hospitalization. Pediatric Sepsis Biomarker Risk Model is a multibiomarker tool for estimating baseline risk of mortality among children with septic shock. We determined if the Pediatric Sepsis Biomarker Risk Model biomarkers have predictive capacity for estimating the risk of hospital mortality and long-term health-related quality-of-life morbidity among children with community-acquired septic shock.

DESIGN

Secondary analysis.

SETTING

Twelve academic PICUs.

PATIENTS

A subset of Life After Pediatric Sepsis Evaluation subjects (n = 173) with available blood samples.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Three predefined outcomes from the Life After Pediatric Sepsis Evaluation investigation were evaluated: all-cause hospital mortality (n = 173), and the composite outcome of mortality or persistent, serious deterioration of health-related quality of life (> 25% below baseline) among surviving children at 1 month (n = 125) or 3 months (n = 117). Pediatric Sepsis Biomarker Risk Model had an area under the receiver operating characteristic curve of 0.73 (95% CI, 0.59-0.87; p = 0.002) for estimating the risk of hospital mortality and was independently associated with increased odds of hospital mortality. In multivariable analyses, Pediatric Sepsis Biomarker Risk Model was not independently associated with increased odds of the composite outcome of mortality or deterioration of persistent, serious deterioration health-related quality of life greater than 25% below baseline. A new decision tree using the Pediatric Sepsis Biomarker Risk Model biomarkers had an area under the receiver operating characteristic curve of 0.87 (95% CI, 0.80-0.95) for estimating the risk of persistent, serious deterioration health-related quality of life at 3 months among children who survived septic shock.

CONCLUSIONS

Pediatric Sepsis Biomarker Risk Model had modest performance for estimating hospital mortality in an external cohort of children with community-acquired septic shock. The Pediatric Sepsis Biomarker Risk Model biomarkers appear to have utility for estimating the risk of persistent, serious deterioration of health-related quality of life up to 3 months after surviving septic shock. These findings suggest an opportunity to develop a clinical tool for early assignment of risk for long-term health-related quality-of-life morbidity among children who survive septic shock.

Authors+Show Affiliations

Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.The University of Utah, Salt Lake City, UT.The University of Utah, Salt Lake City, UT.Children's Hospital of Philadelphia, Philadelphia, PA.Children's Hospital of Detroit, Detroit, MI.Nationwide Children's Hospital, Columbus, OH.Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.Children's Hospital of Colorado, Aurora, CO.Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.The University of Utah, Salt Lake City, UT.Texas A&M University, College Station, TX.Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

33003178

Citation

Wong, Hector R., et al. "Biomarkers for Estimating Risk of Hospital Mortality and Long-Term Quality-of-Life Morbidity After Surviving Pediatric Septic Shock: a Secondary Analysis of the Life After Pediatric Sepsis Evaluation Investigation." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 22, no. 1, 2021, pp. 8-15.
Wong HR, Reeder RW, Banks R, et al. Biomarkers for Estimating Risk of Hospital Mortality and Long-Term Quality-of-Life Morbidity After Surviving Pediatric Septic Shock: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation Investigation. Pediatr Crit Care Med. 2021;22(1):8-15.
Wong, H. R., Reeder, R. W., Banks, R., Berg, R. A., Meert, K. L., Hall, M. W., McQuillen, P. S., Mourani, P. M., Chima, R. S., Sorenson, S., Varni, J. W., McGalliard, J., & Zimmerman, J. J. (2021). Biomarkers for Estimating Risk of Hospital Mortality and Long-Term Quality-of-Life Morbidity After Surviving Pediatric Septic Shock: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation Investigation. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 22(1), 8-15. https://doi.org/10.1097/PCC.0000000000002572
Wong HR, et al. Biomarkers for Estimating Risk of Hospital Mortality and Long-Term Quality-of-Life Morbidity After Surviving Pediatric Septic Shock: a Secondary Analysis of the Life After Pediatric Sepsis Evaluation Investigation. Pediatr Crit Care Med. 2021 01 1;22(1):8-15. PubMed PMID: 33003178.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biomarkers for Estimating Risk of Hospital Mortality and Long-Term Quality-of-Life Morbidity After Surviving Pediatric Septic Shock: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation Investigation. AU - Wong,Hector R, AU - Reeder,Ron W, AU - Banks,Russell, AU - Berg,Robert A, AU - Meert,Kathleen L, AU - Hall,Mark W, AU - McQuillen,Patrick S, AU - Mourani,Peter M, AU - Chima,Ranjit S, AU - Sorenson,Samuel, AU - Varni,James W, AU - McGalliard,Julie, AU - Zimmerman,Jerry J, AU - ,, PY - 2022/01/01/pmc-release PY - 2020/10/2/pubmed PY - 2021/4/22/medline PY - 2020/10/1/entrez SP - 8 EP - 15 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 22 IS - 1 N2 - OBJECTIVES: The Life After Pediatric Sepsis Evaluation investigation recently reported that one-third of children who survive sepsis experience significant health-related quality-of-life impairment compared with baseline at 1 year after hospitalization. Pediatric Sepsis Biomarker Risk Model is a multibiomarker tool for estimating baseline risk of mortality among children with septic shock. We determined if the Pediatric Sepsis Biomarker Risk Model biomarkers have predictive capacity for estimating the risk of hospital mortality and long-term health-related quality-of-life morbidity among children with community-acquired septic shock. DESIGN: Secondary analysis. SETTING: Twelve academic PICUs. PATIENTS: A subset of Life After Pediatric Sepsis Evaluation subjects (n = 173) with available blood samples. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three predefined outcomes from the Life After Pediatric Sepsis Evaluation investigation were evaluated: all-cause hospital mortality (n = 173), and the composite outcome of mortality or persistent, serious deterioration of health-related quality of life (> 25% below baseline) among surviving children at 1 month (n = 125) or 3 months (n = 117). Pediatric Sepsis Biomarker Risk Model had an area under the receiver operating characteristic curve of 0.73 (95% CI, 0.59-0.87; p = 0.002) for estimating the risk of hospital mortality and was independently associated with increased odds of hospital mortality. In multivariable analyses, Pediatric Sepsis Biomarker Risk Model was not independently associated with increased odds of the composite outcome of mortality or deterioration of persistent, serious deterioration health-related quality of life greater than 25% below baseline. A new decision tree using the Pediatric Sepsis Biomarker Risk Model biomarkers had an area under the receiver operating characteristic curve of 0.87 (95% CI, 0.80-0.95) for estimating the risk of persistent, serious deterioration health-related quality of life at 3 months among children who survived septic shock. CONCLUSIONS: Pediatric Sepsis Biomarker Risk Model had modest performance for estimating hospital mortality in an external cohort of children with community-acquired septic shock. The Pediatric Sepsis Biomarker Risk Model biomarkers appear to have utility for estimating the risk of persistent, serious deterioration of health-related quality of life up to 3 months after surviving septic shock. These findings suggest an opportunity to develop a clinical tool for early assignment of risk for long-term health-related quality-of-life morbidity among children who survive septic shock. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/33003178/Biomarkers_for_Estimating_Risk_of_Hospital_Mortality_and_Long_Term_Quality_of_Life_Morbidity_After_Surviving_Pediatric_Septic_Shock:_A_Secondary_Analysis_of_the_Life_After_Pediatric_Sepsis_Evaluation_Investigation_ L2 - https://doi.org/10.1097/PCC.0000000000002572 DB - PRIME DP - Unbound Medicine ER -