Sepsis linked to emergence and progression of coexisting diseases in children

USA: According to research from a national cohort of seriously ill children who survived sepsis and was published in JAMA Pediatrics, 1 in 5 of these kids went on to acquire or progress from a condition of interest after being hospitalized for sepsis.

When it comes to mortality and morbidity, pediatric sepsis is a major contributor in low- and middle-income (LMIC) nations, where an enormous number of infectious illnesses are present. The adoption of protocol-based care has decreased sepsis-related mortality despite a lack of resources, yet pediatric sepsis survivors have a risk of poor functional outcomes. After sepsis, children frequently endure physical, cognitive, or emotional consequences. The evolution or development of medical issues following pediatric sepsis, however, is poorly understood.

The goal of the study was to measure the onset and course of four prevalent illnesses six months after sepsis and see whether they varied among severely ill children who had been hospitalized for sepsis as opposed to nonsepsis.

Using a nationwide administrative claims database, the cohort study of 1,01,511 children (under 19 years) hospitalized for sepsis or non-sepsis examined those patients (January 1, 2010, to June 30, 2018). There were identified 96,361 survivors of non-sepsis intensive care unit hospitalizations and 5150 survivors of pediatric sepsis. Management and analysis of the data were done between April 1, 2020, and July 7, 2022. Sepsis-related critical care unit hospitalizations were compared to all-cause intensive care unit hospitalizations that did not contain sepsis to determine exposure.

Four target conditions—chronic respiratory failure, seizure disorder, nutritional supplement dependence, and chronic kidney disease—developing within six months of hospital discharge were the primary outcomes. The four target diseases' advancement among children who already had them before being hospitalized were secondary outcomes. Diagnostic and procedural codes, codes for durable medical equipment, and codes for prescription drugs were used to identify outcomes. Employing logistic regression with matched weights, variations between pediatric sepsis patients and pediatric nonsepsis patients who sustained intensive care unit hospitalization were studied in the onset and progression of illnesses.

Key highlights of the research:

• A new target condition arose in 670 (51.0%) of the 5150 participants, while disease progression occurred in 385 (183.4%) of the participants with a pre-existing target condition.
• 5150 survivors were counted, and 998 of them (19.4%) had at least one ailment that had developed or progressed.
• Hospitalizations for sepsis were more likely to result in the development of new conditions than hospitalizations for nonsepsis.
• fewer people had new seizure disorders (4.6% versus 6.0%; OR 0.77 [95% CI, 0.66-0.89]).
• Gradual supplemental nutritional reliance increased (1.5% vs. 0.5%; OR, 2.95 [95% CI, 1.60-5.42]), progressive epilepsy decreased (33.7% vs. 40.6%; OR, 0.74 [95% CI, 0.65-0.86]), and progressive chronic kidney disease and progressive respiratory failure were comparable among survivors of sepsis vs. nonsepsis admitted to an intensive care unit.

The authors concluded that survivors of pediatric sepsis may benefit from rigorous follow-up to find and treat any new or deteriorating medical comorbid problems.

REFERENCE

Carlton EF, Gebremariam A, Maddux AB, et al. New and Progressive Medical Conditions After Pediatric Sepsis Hospitalization Requiring Critical Care. JAMA Pediatr. Published online October 10, 2022.

doi:10.1001/jamapediatrics.2022.3554