he epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational stud

Author(s):Show less -

de Souza, Daniela Carla ^{[1, 2]} ; Martin, Joelma Goncalves ^[3] ; Lanziotti, Vanessa Soares ^{[4, 5]} ; de Oliveira, Claudio Flauzino ^[1] ; Tonial, Cristian ^[6] ; de Carvalho, Werther Brunow ^[7] ; Fioretto, Jose Roberto ^[3] ; Piva, Jefferson Pedro ^[6] ; Troster, Eduardo Juan ^[8] ; Bossa, Aline Siqueira ^[1] ; Gregorini, Flavia ^[1] ; Ferreira, Josiane ^[1] ; Lubarino, Juliana ^[1] ; Cavalcanti, Alexandre Biasi ^{[1, 9]} ; Machado, Flavia Ribeiro ^{[1, 10]} ; Investigators, SPREAD PED ; Network, Inst Latino Amer Sepsis

Affiliation

^[1] Inst Latino Americano Sepsis, BR-04039002 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Pediat Intens Care Unit, Dept Pediat, Hosp Univ, Sao Paulo - Brazil

^[3] Univ Estadual Paulista UNESP, Dept Pediat, Med Sch, Botucatu, SP - Brazil

^[4] Univ Fed Rio de Janeiro, Pediat Intens Care Unit, Rio De Janeiro - Brazil

^[5] Univ Fed Rio de Janeiro, Res & Educ Div, Maternal & Child Hlth Postgrad Program, Rio De Janeiro - Brazil

^[6] Univ Fed Rio Grande do Sul, Pediat Intens Care Unit, Hosp Clin Porto Alegre, Porto Alegre, RS - Brazil

^[7] Univ Sao Paulo, Pediat Intens Care Neonatol, Dept Pediat, Fac Med, Sao Paulo - Brazil

^[8] Fac Israelita Ciancias Saude Albert Einstein, Med Sch, Sao Paulo - Brazil

^[9] HCor Res Inst, Sao Paulo - Brazil

^[10] Univ Fed Sao Paulo, Anesthesiol Pain & Intens Care Dept, Hosp Sao Paulo, Sao Paulo - Brazil

• Document type: Journal article
• Source: LANCET CHILD & ADOLESCENT HEALTH; v. 5, n. 12, p. 873-881, DEC 2021.
• Web of Science Citations: 3

Abstract

Background Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality. Methods We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates. Findings Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25.0% (95% CI 21.6-28.8), with a mortality rate of 19.8% (15.4-25.2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1.21, 95% CI 1.14-1.29, p<0.0001), unknown vaccination status (2.57, 1.26-5.24; p=0.011), incomplete vaccination status (2.16, 1.19-3.92; p=0.012), health care-associated infection (2.12, 1.23-3.64, p=0.0073), and compliance with antibiotics (2.38, 1.46-3.86, p=0.0007). The estimated incidence of PICU-treated sepsis was 74.6 cases per 100 000 paedi-atric population (95% CI 61.5-90.5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083). Interpretation In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality. Copyright (C) 2021 Elsevier Ltd. All rights reserved. (AU)

• FAPESP's process: 17/21052-0 - Sepsis: mechanisms, therapeutic targets and epidemiology
• Grantee: Reinaldo Salomão
• Support Opportunities: Research Projects - Thematic Grants