Descriptive statistics and risk factor analysis of children with community-acquired septic shock

Shinya Miura; Nobuaki Michihata; Yohei Hashimoto; Hiroki Matsui; Kiyohide Fushimi; Hideo Yasunaga

doi:10.1186/s40560-023-00652-9

Descriptive statistics and risk factor analysis of children with community-acquired septic shock

J Intensive Care. 2023 Feb 13;11(1):6. doi: 10.1186/s40560-023-00652-9.

Authors

Shinya Miura^{1

2}, Nobuaki Michihata³, Yohei Hashimoto^{4

5}, Hiroki Matsui⁵, Kiyohide Fushimi⁶, Hideo Yasunaga⁵

Affiliations

¹ Department of Pediatrics, St. Marianna University School of Medicine, 2 Chome-16-1 Sugao, Miyamae Ward, Kawasaki, Kanagawa, Japan. shin.nya1982@gmail.com.
² Teikyo University Graduate School of Public Health, Tokyo, Japan. shin.nya1982@gmail.com.
³ Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
⁶ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

Abstract

Background: Children with community-acquired septic shock can rapidly deteriorate and die in acute-care hospitals. This study aimed to describe the mortality, timing, and risk factors in children with community-acquired septic shock.

Methods: This is a retrospective cohort study using a national inpatient database in Japan. The study population included children (age < 20 years) who were admitted to acute-care hospitals with a diagnosis of sepsis from July 2010 to March 2020, who were treated with antibiotics, and who were supported with vasoactive drugs within three days of hospitalization. We used a Cox proportional-hazards regression model to identify risk factors for earlier death.

Results: Among 761 eligible children, the median age was 3 (interquartile range, 0-11) years and 57.2% had underlying conditions. Among these, 67.1% were admitted to accredited intensive care units within three days of hospitalization and 38.6% were transported from other hospitals. The median hospital volume, defined as the number of eligible children in each hospital over the study period, was 4 (interquartile range, 2-11). Overall, 244 children died (in-hospital mortality rate, 32.1%). Among them, 77 (31.6%) died on the first day, and 156 (63.9%) died within three days of hospitalization. A Cox proportional-hazards regression model showed that earlier death was associated with lower hospital volume and age 1-5 years, whereas it was inversely associated with admission to an accredited intensive care unit and transport from other hospitals. Among 517 survivors, 178 (34.4%) were discharged with comorbidities.

Conclusions: Children with community-acquired septic shock had high mortality, and early death was common. Our findings may warrant future efforts to enhance the quality of initial resuscitation for sepsis in low-volume hospitals and to ensure a healthcare system in which children with sepsis can be treated in accredited intensive care units.

Keywords: Children; Community-acquired; Epidemiology; Pediatric; Sepsis; Septic shock.

Abstract

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