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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2021

Open Access 01-12-2021 | Shock | Research

Validation of the pediatric refractory septic shock definition: post hoc analysis of a controlled trial

Authors: Luc Morin, Karthik Narayanan Ramaswamy, Muralidharan Jayashree, Arun Bansal, Karthi Nallasamy, Pierre Tissieres, Sunit Singhi

Published in: Annals of Intensive Care | Issue 1/2021

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Abstract

Background

The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) developed and validated a definition of pediatric refractory septic shock (RSS), based on two septic shock scores (SSS). Both bedside SSS (bSSS) and computed SSS (cSSS) were found to be strongly associated with mortality. We aimed at assessing the accuracy of the RSS definition on a prospective cohort from India.

Methods

Post hoc analysis of a cohort issued from a double-blind randomized trial that compared first-line vasoactive drugs in children with septic shock. Sequential bSSS and cSSS from 60 children (single-center study, 53% mortality) were analyzed. The prognostic value of the ESPNIC RSS definition was tested for 28-day all-cause mortality.

Results

In this septic shock cohort, RSS was diagnosed in 35 patients (58.3%) during the first 24 h. Death occurred in 30 RSS patients (85.7% mortality) and in 2 non-RSS patients (8% mortality), OR = 60.9 [95% CI: 10.5–676.2], p < 0.001 with a median delay from sepsis onset of 3 days [1.0–6.7]. Among patients diagnosed with RSS, the mortality was not significantly different according to vasopressors randomization. Diagnosis of RSS with bSSS and cSSS had a high discrimination for death with an area under the receiver operating curve of 0.916 [95% CI: 0.843–0.990] and 0.925 [95% CI: 0.845–1.000], respectively. High prognostic accuracy of the bSSS was found in the first hours following intensive care admission. The best interval of prognostication occurs after the 12th hour following treatment initiation (AUC 0.973 [95% CI: 0.925–1.000]).

Conclusions

The ESPNIC refractory septic shock definition accurately identifies, within the first 6 h of septic shock management, children with lethal outcome.
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Metadata
Title
Validation of the pediatric refractory septic shock definition: post hoc analysis of a controlled trial
Authors
Luc Morin
Karthik Narayanan Ramaswamy
Muralidharan Jayashree
Arun Bansal
Karthi Nallasamy
Pierre Tissieres
Sunit Singhi
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2021
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-021-00822-8

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