Pediatric Sepsis Phenotype in a Single-Center Cohort Covering 2010–2020: Evolution in Day 1–Day 3 Trajectory and Potential Prognostic Value
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To examine the utility of day 3 sepsis phenotype classifications compared with day 1 and whether these could be reliably identified using routine clinical data on day 1. DESIGN: Retrospective cohort study of pediatric patients managed 2010-2014 and 2018-2020. SETTING: Academic children's hospital. PATIENTS: One thousand eight hundred twenty-eight children (1 mo to 18 yr old) admitted to the PICU with suspected infection who received a minimum of 7 days of systemic antibiotics. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Subjects showed significant evolution of phenotype from day 1 to day 3, with 31.7-60.9% remaining the same type. Outcomes were worst in those classifying as type D on day 3, with mortality as high as 16.6% in those that were classified as type D on both days 1 and 3, as well as 11.3% in those initially classified as type C (a lower mortality type) on day 1 but type D on day 3. Accurate statistical prediction of day 3 types using multinomial logistic regression and random forest and day 1 data was poor, despite attempts to improve performance. CONCLUSIONS: In our retrospective cohort of patients with sepsis, we identified significant evolution in phenotype over the first 3 days of illness. Day 3 phenotypes may provide more accurate statistical prediction of outcomes, but identification of day 3 phenotypes using data available early in the course of illness is challenging. New methods will likely be required to improve performance in this area.
Source: Pediatric Critical Care Medicine
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Award: G2629787543
OpenAlex ID: W4408054820