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

Publication ,  Journal Article
Patterson, SG; Lamb, CK; Gong, W; Resser, J; Lindsell, CJ; Van Driest, SL; Stark, RJ
Published in: Chest
November 2023

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 × 103/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.

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Published In

Chest

DOI

EISSN

1931-3543

Publication Date

November 2023

Volume

164

Issue

5

Start / End Page

1204 / 1215

Location

United States

Related Subject Headings

  • Syndrome
  • Sepsis
  • Retrospective Studies
  • Respiratory System
  • Prevalence
  • Immunosuppression Therapy
  • Humans
  • Death
  • Child
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Patterson, S. G., Lamb, C. K., Gong, W., Resser, J., Lindsell, C. J., Van Driest, S. L., & Stark, R. J. (2023). Pediatric Persistent Inflammation, Immunosuppression, and Catabolism Syndrome Prevalence in Sepsis-Related Mortalities: A 23-Year Institutional History. Chest, 164(5), 1204–1215. https://doi.org/10.1016/j.chest.2023.05.002
Patterson, Stephanie G., Celia K. Lamb, Wu Gong, Jackson Resser, Christopher J. Lindsell, Sara L. Van Driest, and Ryan J. Stark. “Pediatric Persistent Inflammation, Immunosuppression, and Catabolism Syndrome Prevalence in Sepsis-Related Mortalities: A 23-Year Institutional History.Chest 164, no. 5 (November 2023): 1204–15. https://doi.org/10.1016/j.chest.2023.05.002.
Patterson SG, Lamb CK, Gong W, Resser J, Lindsell CJ, Van Driest SL, et al. Pediatric Persistent Inflammation, Immunosuppression, and Catabolism Syndrome Prevalence in Sepsis-Related Mortalities: A 23-Year Institutional History. Chest. 2023 Nov;164(5):1204–15.
Patterson, Stephanie G., et al. “Pediatric Persistent Inflammation, Immunosuppression, and Catabolism Syndrome Prevalence in Sepsis-Related Mortalities: A 23-Year Institutional History.Chest, vol. 164, no. 5, Nov. 2023, pp. 1204–15. Pubmed, doi:10.1016/j.chest.2023.05.002.
Patterson SG, Lamb CK, Gong W, Resser J, Lindsell CJ, Van Driest SL, Stark RJ. Pediatric Persistent Inflammation, Immunosuppression, and Catabolism Syndrome Prevalence in Sepsis-Related Mortalities: A 23-Year Institutional History. Chest. 2023 Nov;164(5):1204–1215.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

November 2023

Volume

164

Issue

5

Start / End Page

1204 / 1215

Location

United States

Related Subject Headings

  • Syndrome
  • Sepsis
  • Retrospective Studies
  • Respiratory System
  • Prevalence
  • Immunosuppression Therapy
  • Humans
  • Death
  • Child
  • 3202 Clinical sciences