Vascular Reactivity Index as an Effective Predictor of Mortality in Children With Refractory Septic Shock

2020 ◽  
pp. 088506662091485 ◽  
Author(s):  
En-Pei Lee ◽  
Lu-Lu Zhao ◽  
Shao-Hsuan Hsia ◽  
Oi-Wa Chan ◽  
Chia-Ying Lin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Vascular Reactivity ◽  
Characteristic Curve ◽  
Pediatric Intensive Care ◽  
Reactivity Index ◽  
Survival Group ◽  
Risk Of Mortality ◽  
Inotropic Score ◽  
Refractory Septic Shock ◽  
Vasoactive Inotropic Score

Background: Vasoplegia is vascular hyporesponsiveness to vasopressors and is an important phenomenon in children with refractory septic shock. This study aimed to develop an objective formula correlated with vasoplegia and evaluate the predictive power for mortality in children with refractory septic shock. Materials and Methods: We retrospectively analyzed children with refractory septic shock admitted to a pediatric intensive care unit (PICU) and monitored their hemodynamics via a pulse index continuous cardiac output (PiCCO) system. Serial hemodynamic data including cardiac index (CI), systemic vascular resistant index (SVRI) and vasoactive-inotropic score (VIS) were recorded during the first 72 hours after PICU admission. We defined vascular reactivity index (VRI) as SVRI/VIS and analyzed the effect of VRI in predicting mortality in children with refractory septic shock. Results: Thirty-three children with refractory septic shock were enrolled. The SVRI was lower in the mortality group compared to the survival group ( P < .05). The average area under the receiver operating characteristic curve of VRI within the first 72 hours was 0.8 and the serial values of VRI were significantly lower in the mortality group during the period from 0 to 48 hours ( P < .05). However, there were no significant differences in serial CI values between the survival and mortality groups. Conclusions: Vasoactive-inotropic score may potentially be used to quantify the severity of vasoplegia based on the clinical response of vessels after resuscitation with vasopressors. Lower VRI levels may indicate a higher risk of mortality in children with septic shock.

scholarly journals Comparison of Predictive Powers for Mortality between Systemic Vascular Resistance Index and Serum Lactate in Children with Persistent Catecholamine-Resistant Shock

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
En-Pei Lee ◽  
Sheng-Chih Chu ◽  
Shao-Hsuan Hsia ◽  
Kuan-Fu Chen ◽  
Oi-Wa Chan ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Perfusion Pressure ◽  
Small Sample Size ◽  
Characteristic Curve ◽  
Resistance Index ◽  
Serum Lactate ◽  
Small Sample ◽  
Survival Group ◽  
Inotropic Score ◽  
Vasoactive Inotropic Score

Persistent catecholamine-resistant shock in children causes severe morbidity and mortality. We aimed to analyze the association between hemodynamics and serum lactate at different time points and 28-day mortality in children with persistent catecholamine-resistant shock. Methods. Twenty-six children with persistent catecholamine-resistant shock were enrolled, and their hemodynamics were monitored using the pulse index continuous cardiac output. Serial cardiac index (CI), systemic vascular resistant index (SVRI), and vasoactive-inotropic score (VIS) were analyzed for the first 24 hours. Associations between hemodynamics, serum lactate, and 28-day mortality were analyzed. Results. The 28-day mortality rate was 53.8%. SVRI and VIS were independent predictors of 28-day mortality. The mortality group had lower serial SVRI and higher VIS than the survival group (p<0.05). Serial SVRI had the highest area under the receiver operating characteristic curve (AUC) for predicting mortality during the first 24 hours of persistent catecholamine-resistant shock. Three important hemodynamic parameters, CI, SVRI and perfusion pressure (MAP-CVP), were significantly correlated with lactate, of which SVRI had the best correlation (r=−0.711, p<0.001). According to the AUC, SVRI was a more powerful predictor of mortality than lactate in persistent catecholamine-resistant shock. After 24 hours of treatment for persistent catecholamine-resistant shock, an SVRI lower than 1284 dyn·s·cm-5·m2 was associated with 28-day mortality. Conclusions. SVRI was an early factor associated with mortality in the pediatric patients with persistent catecholamine-resistant shock potentially and had the good correlation with serum lactate. An SVRI more than 1284 dyn·s·cm-5·m2 during the first 24 hours of persistent catecholamine-resistant shock was associated with favorable outcomes. The result should be used with caution due to the small sample size.

scholarly journals Threshold of Inotropic Score and Vasoactive–Inotropic Score for Predicting Mortality in Pediatric Septic Shock

2021 ◽  
Author(s):  
Dipu Kallekkattu ◽  
Ramachandran Rameshkumar ◽  
Muthu Chidambaram ◽  
Kandamaran Krishnamurthy ◽  
Tamil Selvan ◽  
...  
Keyword(s):  
Septic Shock ◽  
Inotropic Score ◽  
Vasoactive Inotropic Score

scholarly journals Mortality rates in pediatric septic shock

2017 ◽  
Vol 56 (5) ◽  
pp. 304 ◽  
Author(s):  
Desy Rusmawatiningtyas ◽  
Nurnaningsih Nurnaningsih
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Mortality Rate ◽  
Fluid Overload ◽  
Pediatric Intensive Care ◽  
Developed Countries ◽  
Mortality Rates ◽  
Study Cohort ◽  
Survival Group

Background Septic shock remains a major cause of morbidity and mortality in children admitted to the intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies have reported mortality rates from pediatric septic shock in intensive care settings in developing countries with limited resources.  Objective  To determine the current mortality rates for pediatric patients with septic shock in a developing country.Methods A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at DR. Sardjito General Hospital. Medical records and charts were reviewed and recorded for diagnoses of septic shock, from November 1st, 2011 to June 30th, 2014. Results  A database of all PICU admissions was assembled, and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicion of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusion  The overall mortality rate for the study cohort was 88.2%.  The median age of patients was 16 months, with 52.2% males. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid at a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects.Conclusion The mortality rate in pediatric septic shock in our hospital is very high. There is a higher incidence of fluid overload in the non-survival group .

Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children

2021 ◽  
Author(s):  
Madhuradhar Chegondi ◽  
Niranjan Vijayakumar ◽  
Ramya Deepthi Billa ◽  
Aditya Badheka ◽  
Oliver Karam
Keyword(s):  
Septic Shock ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Pediatric Intensive Care ◽  
Prognostic Indicator ◽  
Clinical Value ◽  
Operating Characteristic Curve ◽  
Pediatric Sepsis ◽  
Sepsis And Septic Shock ◽  
Platelet Mass

AbstractPlatelet mass index (PMI) as a prognostic indicator in pediatric sepsis is not reported. In this retrospective observational study, we evaluated PMI's performance as a prognostic indicator in children aged younger than 18 years with sepsis and septic shock in relationship with survival. Over 5 years, we collected data of 122 children admitted to our pediatric intensive care unit (PICU). PMI accuracy was assessed with sensitivity and specificity and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). The median PMI values on days 1 and 3 of PICU admission were lower among nonsurvivors. On day 1 of PICU admission, a cutoff PMI value of 1,450 fL/nL resulted in a sensitivity of 72% and a specificity of 69%, and the AUC was 0.70 (95% confidence interval [CI]: 0.55–0.86). Similarly, on day 3, a cutoff of 900 fL/nL resulted in a sensitivity of 71% and a specificity of 70%, and the AUC was 0.76 (95% CI: 0.59–0.92). Our exploratory study suggests that low PMI in children with septic shock is associated with increased mortality. Considering the PMI's fair performance, further studies have to assess its clinical value.

scholarly journals Afterload-related cardiac performance identifies cardiac impairment and associates with outcome in patients with septic shock: a retrospective cohort study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Wei-yan Chen ◽  
Zhen-hui Zhang ◽  
Li-li Tao ◽  
Qi Xu ◽  
Xing Wei ◽  
...  
Keyword(s):  
Septic Shock ◽  
Proportional Hazards ◽  
Characteristic Curve ◽  
Cox Proportional Hazards ◽  
Cardiac Performance ◽  
Apache Ii Score ◽  
Septic Cardiomyopathy ◽  
Exponential Relationship ◽  
Strong Linear Correlation ◽  
Inotropic Score

Abstract Background Septic patients with cardiac impairment are with high mortality. Afterload-related cardiac performance (ACP), as a new tool for diagnosing septic cardiomyopathy (SCM), still needs to be evaluated for its impact on the prognosis for patients with septic shock. Methods In this retrospective study, 100 patients with septic shock undertaken PiCCO monitoring were included. The ability of ACP, cardiac index (CI), and cardiac power index (CPI) to discriminate between survivors and non-survivors was tested by comparing the area under the receiver operating characteristic curve (AUROC) analysis. Cox proportional hazards regression analyses were performed to assess the associations of ACP with day-28 mortality. Curve estimation was used to describe the relationship between the hazard ratio (HR) of death and ACP. Results ACP had a strong linear correlation with CI and CPI (P < 0.001). ACP demonstrated significantly greater discrimination for day-28 mortality than CI before adjusted [AUROC 0.723 (95% CI 0.625 to 0.822) vs. 0.580 (95% CI 0.468 to 0.692), P = 0.007] and CPI after adjusted [AUROC 0.693 (95% CI 0.590 to 0.797) vs. 0.448 (0.332 to 0.565), P < 0.001]. Compared with ACP > 68.78%, HR for ACP ≤ 68.78% was 3.55 (1.93 to 6.54) (P < 0.001). When adjusted with age, APACHE-II score, Vasoactive Inotropic Score, Lactate, CRRT, day-1 volume, fibrinogen and total bilirubin as possible confounders, and decrease ACP are still associated with increasing day-28 mortality (P < 0.05). An exponential relationship was observed between ACP12h and HR of day-28 death. Conclusions Our results suggested thatACP could improve mortality predictions when compared to CI and CPI. Decreased ACP was still an independent risk factor for increased day-28 mortality.

Extracorporeal Membrane Oxygenation for Refractory Septic Shock in Children

PEDIATRICS ◽  
1994 ◽  
Vol 93 (5) ◽  
pp. 726-729
Author(s):  
John Beca ◽  
Warwick Butt
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Extracorporeal Membrane Oxygenation ◽  
Demographic Data ◽  
Pediatric Intensive Care ◽  
Organ System ◽  
Severe Respiratory Failure ◽  
Prism Score ◽  
Membrane Oxygenation ◽  
Refractory Septic Shock

Objective. To review demographic data and outcome of children who received extracorporeal membrane oxygenation (ECMO) for refractory septic shock. Method. Review of medical charts of nine children receiving ECMO for culture-proven refractory septic shock treated in a multidisciplinary pediatric intensive care unit. Results. Median age was 12 years and median weight was 45 kg. Median inotrope requirements (µg/kg per minute) before ECMO were dopamine, 15; dobutamine, 12.5; epinephrine, 4; and norepinephrine, 3.5. Four children received two inotropes concurrently, and five received three or more. All nine patients had severe respiratory failure; eight had evidence of other organ system dysfunction, with six having five or more organ system dysfunctions. Median PRISM score was 27. Median duration of ECMO was 137 hours. Within 24 hours of starting ECMO, 7 of 9 children had all inotropes stopped. Four patients died and five survived, all of whom are leading normal lives. Conclusion. In this small group of children with probably fatal septic shock, ECMO was successfully supported the circulation and 5 of the 9 children survived. We suggest that septic shock should not be considered a contra-indication to ECMO.

Maximum Norepinephrine Dosage Within 24 Hours as an Indicator of Refractory Septic Shock: A Retrospective Study

2019 ◽  
Vol 35 (11) ◽  
pp. 1285-1289
Author(s):  
Daisuke Kasugai ◽  
Akihiko Hirakawa ◽  
Masuyuki Ozaki ◽  
Kazuki Nishida ◽  
Takao Ikeda ◽  
...  
Keyword(s):  
Septic Shock ◽  
Medical Center ◽  
Characteristic Curve ◽  
Academic Medical Center ◽  
Do Not Resuscitate ◽  
Weighting Method ◽  
Icu Admission ◽  
Academic Medical ◽  
Refractory Septic Shock ◽  
Multivariable Regression

Background: The management of refractory septic shock remains a major challenge in critical care and its early indicators are not fully understood. We hypothesized that the maximum norepinephrine dosage within 24 hours of intensive care unit (ICU) admission may be a useful indicator of early mortality in patients with septic shock. Methods: In this retrospective single-center observational study, patients with septic shock admitted to the emergency ICU of an academic medical center between April 2011 and March 2017 were included. Individuals with cardiac arrest and those with do-not-resuscitate orders before admission were excluded. We analyzed if the maximum norepinephrine dosage within 24 hours of ICU admission (MD24) was associated with 7-day mortality. Results: Among 152 patients with septic shock, 20 (15%) did not survive by day 7. The receiver operating characteristic curve analysis for predicting 7-day mortality revealed a cutoff of MD24 of 0.6 μg/kg/min (sensitivity 47%, specificity 93%). In the multivariable regression analysis, a higher MD24 was significantly associated with 7-day mortality (odds ratio: 7.20; 95% confidence interval [CI]: 2.02-25.7; P = .002) but not with 30-day mortality. Using the inverse probability of treatment weighting method in a propensity scoring analysis, a higher MD24 was significantly associated with 7-day (hazard ratio [HR]: 8.9; 95% CI: 3.2-25.0; P < .001) and 30-day mortality (HR: 2.7; 95% CI: 1.2-5.8; P = .012). Conclusions: An MD24 ≥0.6 μg/kg/min was significantly associated with 7-day mortality in patients with septic shock and may therefore be a useful indicator of refractory septic shock.

scholarly journals Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

2020 ◽  
Vol 26 ◽  
pp. 107602962093520
Author(s):  
Chunxia Wang ◽  
Yun Cui ◽  
Huijie Miao ◽  
Ting Sun ◽  
Ye Lu ◽  
...  
Keyword(s):  
Liver Injury ◽  
Clinical Utility ◽  
Prospective Observational Study ◽  
Operating Characteristic ◽  
Pediatric Patients ◽  
Characteristic Curve ◽  
Pediatric Intensive Care ◽  
Decision Curve Analysis ◽  
Risk Of Mortality ◽  
Pediatric Sepsis

Vitronectin (VTN) is a key regulator of coagulation, but clinical relevance of serum VTN in pediatric sepsis remains poorly defined. The aim of this study was to access the value of serum VTN level on pediatric intensive care unit (PICU) admission in children with sepsis. Pediatric patients with sepsis were enrolled from January 2018 to December 2018. The serum VTN levels were determined on PICU admission, and the association of serum VTN level with PICU mortality and organ dysfunction was assessed. Serum VTN levels were significantly lower in nonsurvivors compared with survivors, in patients with septic shock compared with patients with sepsis, or in patients with sepsis-associated acute liver injury (ALI) compared with patients without ALI. Serum VTN level was associated with PICU mortality (odds ratio [OR]: 0.958, 95% CI: 0.927-0.996; P = .010) or ALI (OR: 0.956, 95% CI: 0.915-0.999; P = .046), but not shock (OR: 0.996, 95% CI: 0.977-1.016; P =.716). The area under receiver operating characteristic curve for VTN in predicting the occurrence of ALI during PICU stay and PICU mortality were 0.760 (95% CI: 0.627- 0.893) and 0.737 (95% CI: 0.544-0.931), respectively. Moreover, VTN plus pediatric risk of mortality (PRISM) III had a better clinical utility according to decision curve analysis compared with VTN or PRISM III alone. These findings suggest that serum VTN level is associated with sepsis-associated ALI and PICU mortality, and VTN plus PRISM III is a powerful predictor of PICU mortality in pediatric patients with sepsis, which have a better clinical benefit compared with VTN or PRISM III alone.

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