Elsevier

The Journal of Pediatrics

Volume 199, August 2018, Pages 194-199.e1
The Journal of Pediatrics

Original Articles
Children with Chronic Disease Bear the Highest Burden of Pediatric Sepsis

https://doi.org/10.1016/j.jpeds.2018.03.056Get rights and content

Objective

To describe the contemporary epidemiology of pediatric sepsis in children with chronic disease, and the contribution of chronic diseases to mortality. We examined the incidence and hospital mortality of pediatric sepsis in a nationally representative sample and described the contribution of chronic diseases to hospital mortality.

Study design

We analyzed the 2013 Nationwide Readmissions Database using a retrospective cohort design. We included non-neonatal patients <19 years of age hospitalized with sepsis. We examined patient characteristics, the distribution of chronic disease, and the estimated national incidence, and described hospital mortality. We used mixed effects logistic regression to explore the association between chronic diseases and hospital mortality.

Results

A total of 16 387 admissions, representing 14 243 unique patients, were for sepsis. The national incidence was 0.72 cases per 1000 per year (54 060 cases annually). Most (68.6%) had a chronic disease. The in-hospital mortality was 3.7% overall—0.7% for previously healthy patients and 5.1% for patients with chronic disease. In multivariable analysis, oncologic, hematologic, metabolic, neurologic, cardiac and renal disease, and solid organ transplantation were associated with increased in-hospital mortality.

Conclusions

More than 2 of 3 children admitted with sepsis have ≥1 chronic disease and these patients have a higher in-hospital mortality than previously healthy patients. The burden of sepsis in hospitalized children is greatest in pediatric patients with chronic disease.

Section snippets

Methods

We used a retrospective cohort design and the Nationwide Readmissions Database (NRD)10 from 2013, which includes 49% of all hospital admissions in the US. The NRD includes hospitalizations for children who were between 1 and 18 years of age from 21 states and hospitalizations for children <1 year of age from 9 states. This study was deemed exempt by the University of Pittsburgh Institutional Review Board.

We estimated the national incidence of sepsis using the weights provided by the NRD and

Results

Of the 14 325 172 admissions in the NRD, 1 227 931 admissions were in patients <19 years of age, of which 309 675 (25.2%) were neonatal patients admitted. Of the 918 256 non-neonatal pediatric admissions, 16 387 met the criteria for sepsis. The estimated national incidence in the pediatric population was 0.72 per 1000, with an estimated 54 060 cases per year (Figure 1).

Discussion

In a nationally representative cohort of pediatric patients with sepsis, we showed that the proportion with a chronic disease has increased compared with prior studies,1, 2, 15 and >68% of admissions now have ≥1 chronic disease. We also found that patients with severe sepsis and septic shock or sepsis with identified organ dysfunction had a higher prevalence of chronic disease than those with sepsis without identified organ dysfunction. This finding underscores the continued national shift in

Data Statement

Data will be made available on request.

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  • Cited by (0)

    Supported by the National Institute of General Medical Sciences (R01GM097471 and R34GM107650) and the National Institutes of Health (R35GM119519). The authors declare no conflicts of interest.

    Portions of this study were presented at the 46th Critical Care Congress, January 21-25, 2017, Honolulu, Hawaii.

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