Pediatric Persistent Inflammation, Immunosuppression, and Catabolism Syndrome Prevalence in Sepsis-Related Mortalities: A 23-Year Institutional History.

Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE

Publication: 2016- : New York : Elsevier
Original Publication: Chicago : American College of Chest Physicians

Immunosuppression Therapy* ; Sepsis*; Humans ; Child ; Retrospective Studies ; Prevalence ; Syndrome ; Death

Background: Delayed mortality in sepsis often is linked to a lack of resolution in the inflammatory cascade termed persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Limited research exists on PICS in pediatric patients with sepsis.
Research Question: What is the prevalence of pediatric PICS (pPICS) in patients who died of sepsis-related causes and what associated pathogen profiles and comorbidities did they have compared with those patients without pPICS who died from sepsis?
Study Design and Methods: A retrospective study of a single institution using a de-identified database from 1997 through 2020 for all patients aged 21 years or younger who died of culture-positive sepsis from a known source and who had laboratory data available were evaluated for the presence of pPICS.
Results: Among records extracted from the institutional database, 557 patients had culture-positive sepsis, with 262 patients having pPICS (47%). Patients with pPICS were more likely to have underlying hematologic or oncologic disease or cardiac disease. In addition, patients who had pPICS showed increased odds of associated fungal infection compared with those patients who did not (OR, 2.69; 95% CI, 1.59-4.61; P < .001). When assessing laboratory criteria, having a sustained absolute lymphocyte count of < 1.0 × 10 ³ /μL was most closely associated with having pPICS compared with other laboratory parameters. Finally, the results of multivariate logistic regression analysis indicated that patients with pPICS were more common in the cardiac ICU, as opposed to the PICU (OR, 3.43; CI, 1.57-7.64; P = .002).
Interpretation: Pediatric patients who died of a sepsis-related cause have a pPICS phenotype nearly one-half of the time. These patients are more likely to be in the cardiac ICU than the pediatric ICU and have associated fungal infections. Special attention should be directed toward this population in future research.
(Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Comment in: Chest. 2023 Nov;164(5):1071-1072. doi: 10.1016/j.chest.2023.05.030. (PMID: 37945185)

Nat Rev Dis Primers. 2016 Jun 30;2:16045. (PMID: 28117397)
Am J Respir Crit Care Med. 2018 Aug 1;198(3):361-369. (PMID: 29470918)
Ann Intensive Care. 2018 Mar 13;8(1):36. (PMID: 29536210)
Sci Rep. 2019 Apr 29;9(1):6579. (PMID: 31036824)
J Trauma Acute Care Surg. 2018 Feb;84(2):342-349. (PMID: 29251709)
Crit Care Clin. 2017 Apr;33(2):245-258. (PMID: 28284293)
JPEN J Parenter Enteral Nutr. 2020 Mar;44(3):391-394. (PMID: 32100881)
Hosp Pediatr. 2020 Dec;10(12):1021-1030. (PMID: 33208389)
Sci Rep. 2020 Dec 9;10(1):21513. (PMID: 33299038)
PLoS One. 2018 Jul 30;13(7):e0198847. (PMID: 30059504)
Pediatr Infect Dis J. 2020 Sep;39(9):781-788. (PMID: 32221163)
Intensive Care Med. 2020 Aug;46(8):1552-1562. (PMID: 32572531)
Nat Rev Immunol. 2013 Dec;13(12):862-74. (PMID: 24232462)
BMJ Open Respir Res. 2019 Jun 29;6(1):e000426. (PMID: 31321058)
Pediatr Crit Care Med. 2012 Mar;13(2):165-73. (PMID: 22079954)
Hosp Pediatr. 2017 Apr;7(4):236-244. (PMID: 28351944)
Crit Care. 2011;15(1):R58. (PMID: 21310070)
Pediatr Crit Care Med. 2005 May;6(3 Suppl):S3-5. (PMID: 15857554)
Front Cardiovasc Med. 2021 Sep 22;8:730157. (PMID: 34631828)
JAMA. 2016 Oct 18;316(15):1555-1564. (PMID: 27706483)
Clin Infect Dis. 1995 Jun;20(6):1526-30. (PMID: 7548503)
JAMA Netw Open. 2019 Aug 2;2(8):e198686. (PMID: 31390038)
Front Pediatr. 2021 May 14;9:686206. (PMID: 34055702)
Pediatr Infect Dis J. 2019 Jun;38(6S Suppl 1):S2-S6. (PMID: 31205236)
J Trauma Acute Care Surg. 2012 Jun;72(6):1491-501. (PMID: 22695412)
Ann Intensive Care. 2023 Mar 12;13(1):17. (PMID: 36906875)
Shock. 2022 Jun 1;57(6):191-199. (PMID: 35759301)
Pediatr Crit Care Med. 2017 Sep;18(9):823-830. (PMID: 28549024)
Ophthalmic Physiol Opt. 2014 Sep;34(5):502-8. (PMID: 24697967)
Shock. 2018 Mar;49(3):249-258. (PMID: 28885387)
Intensive Care Med. 2011 Mar;37(3):525-32. (PMID: 21153402)
Nutr Clin Pract. 2021 Feb;36(1):22-28. (PMID: 33125793)
Crit Care Med. 2011 Aug;39(8):1913-21. (PMID: 21532476)
Intensive Care Med. 2021 Nov;47(11):1181-1247. (PMID: 34599691)
N Engl J Med. 2003 Apr 17;348(16):1546-54. (PMID: 12700374)
Am J Respir Crit Care Med. 2009 Oct 1;180(7):640-8. (PMID: 19590022)
Ann Surg. 2017 Apr;265(4):827-834. (PMID: 27163951)
Cell Mol Immunol. 2021 Aug;18(8):2057-2058. (PMID: 34282298)
Clin Pharmacol Ther. 2008 Sep;84(3):362-9. (PMID: 18500243)
Crit Care. 2019 Jul 3;23(1):241. (PMID: 31269976)
Lancet. 2020 Jan 18;395(10219):200-211. (PMID: 31954465)
Pediatr Crit Care Med. 2020 Jan;21(1):42-49. (PMID: 31246738)
Crit Care Med. 2002 May;30(5):1140-5. (PMID: 12006816)
J Hum Nutr Diet. 2021 Apr;34(2):365-373. (PMID: 32767403)
J Pediatr Health Care. 2014 Nov-Dec;28(6):550-4. (PMID: 24929844)
Pediatr Crit Care Med. 2021 Dec 1;22(12):e636-e639. (PMID: 34261947)
J Immunol. 2005 Mar 15;174(6):3765-72. (PMID: 15749917)
J Trauma Acute Care Surg. 2016 Sep;81(3):525-32. (PMID: 27398984)

R35 GM138191 United States GM NIGMS NIH HHS; S10 RR025141 United States RR NCRR NIH HHS; UL1 TR002243 United States TR NCATS NIH HHS; UL1 TR000445 United States TR NCATS NIH HHS; UL1 RR024975 United States RR NCRR NIH HHS

Keywords: cardiac disease; chronic critical illness; fungal infections; immunosuppression; sepsis

Date Created: 20230510 Date Completed: 20231113 Latest Revision: 20241102

20241102

PMC10635837

10.1016/j.chest.2023.05.002

37164130