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Intensive Care Medicine

, Volume 38, Issue 7, pp 1191–1197 | Cite as

Incidence and risk factors for mortality in paediatric severe sepsis: results from the national paediatric intensive care registry in Japan

  • Nobuaki ShimeEmail author
  • Tatsuya Kawasaki
  • Osamu Saito
  • Yoko Akamine
  • Yuichiro Toda
  • Muneyuki Takeuchi
  • Hiroko Sugimura
  • Yoshio Sakurai
  • Masatoshi Iijima
  • Ikuya Ueta
  • Naoki Shimizu
  • Satoshi Nakagawa
Pediatric Original

Abstract

Purpose

To assess the incidence, background, outcome and risk factors for death of severe sepsis in Japanese paediatric intensive care units (PICUs).

Methods

A data analysis of a prospective, multicentre, 3-year case registry from nine medical-surgical Japanese PICUs. Children with severe sepsis, aged 0–15 years, who were consecutively admitted to the participating PICUs from 1 January 2007 to 31 December 2009 were enrolled. The incidence, background, causative pathogens or infective foci, outcome and risk factors for death caused by severe sepsis were analysed.

Results

One hundred forty-one cases were registered. After the exclusion of 14 patients because of incomplete data or inappropriate entry, 127 patients were eligible for the analysis. There were 60 boys and 67 girls, aged 23 [5–68] (median [IQR]) months and weighed 10 [5.5–16.5] kg. The incidence was 1.4 % of total PICU admissions. Sepsis was community-acquired in 35 %, PICU-acquired in 37 % and acquired in hospital general wards in 28 %. Methicillin-resistant Staphylococcus aureus was the most frequent pathogen. The crude 28-day mortality was 18.9 %, comparable to the mean PIM-2 predicted mortality (17.7 %). The mortality rate in patients with shock was significantly increased to 28 % compared to those without shock (5 %). The presences of existing haematological disorders (OR 8.97, 95 % CI, 1.56–51.60) and shock (OR 5.35, 1.04–27.44) were significant factors associated with mortality by multivariate analysis.

Conclusions

The mortality from severe sepsis/septic shock in Japanese PICUs was ~19 %. Haematological disorders and presence of shock were associated with death.

Keywords

Severe sepsis Septic shock Paediatric Mortality Risk factors 

Notes

Acknowledgments

The authors would like to thank all the participants in this registry and Dr. Graeme MacLaren (National University of Singapore) for his assistance in English editing. This study was conducted without any financial support.

Conflicts of interest

The authors have no potential conflict of interest to disclose.

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Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Nobuaki Shime
    • 1
    Email author
  • Tatsuya Kawasaki
    • 2
  • Osamu Saito
    • 3
  • Yoko Akamine
    • 4
  • Yuichiro Toda
    • 5
  • Muneyuki Takeuchi
    • 6
  • Hiroko Sugimura
    • 7
  • Yoshio Sakurai
    • 8
  • Masatoshi Iijima
    • 9
  • Ikuya Ueta
    • 2
  • Naoki Shimizu
    • 3
  • Satoshi Nakagawa
    • 10
  1. 1.Department of Anaesthesiology and Intensive CareKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of Paediatric Critical CareShizuoka Children’s HospitalShizuokaJapan
  3. 3.Department of Paediatric Emergency and Critical Care MedicineTokyo Metropolitan Children’s Medical CentreFuchuJapan
  4. 4.Department of Paediatric Intensive Care MedicineNagano Children’s HospitalAuzuminoJapan
  5. 5.Department of Anaesthesiology and ResuscitologyOkayama University HospitalOkayamaJapan
  6. 6.Department of Anaesthesiology and Intensive Care MedicineOsaka Medical Center and Research Institute for Maternal and Child HealthIzumiJapan
  7. 7.Department of Intensive Care MedicineChiba Children’s HospitalChibaJapan
  8. 8.Department of PaediatricsSaitama Medical UniversityKawagoeJapan
  9. 9.Department of PaediatricsJikei Medical UniversityTokyoJapan
  10. 10.Department of Critical Care MedicineNational Centre for Child Health and DevelopmentTokyoJapan

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