Application of New Pediatric Sepsis Definition to a Multicenter Observational Cohort of Previously Enrolled Severe Sepsis Patients Defined by SIRS Plus Organ Dysfunction
Year: 2025
Type: article
Abstract: Introduction In 2024, a Society of Critical Care Medicine task force updated the pediatric sepsis definition from the presence of suspected or confirmed infection, and a systemic inflammatory response (SIRS) with organ dysfunction, to a novel definition. Our objective is to identify how many patients previously identified as having severe sepsis would continue to meet the new definition. Materials and methods We performed a secondary analysis of the Phenotyping Sepsis-Induced Multiple Organ Failure cohort of 401 children with suspected or confirmed infection, two of four SIRS criteria and organ dysfunction enrolled between 2015-2017. We calculated a modified Phoenix Sepsis Criteria Score (mPSC) for participants and compared those with mPSC of greater than or equal to 2 or less than 2 according to the 2024 definition. Results Of 401 children, 132 (33%) did not meet mPSC definitions. While children meeting mPSC had more organ dysfunction, the total mortality did not differ. One in 4 children requiring extracorporeal membrane oxygenation and 1 in 4 mortalities did not meet the mPSC definition. In logistic regression models, in the complete cohort, hematologic (OR 4.4, 95% CI: 1.8-10.2, P -value = .001), central nervous system (OR 2.3, 95% CI: 1.0-5.1, P -value = .046) and renal failure (OR: 3.2, 95% CI:1.2-7.9, P -value = .017) predicted mortality; in the mPSC subgroup pulmonary (OR: 3.6, 95% CI:1.3-13.3, P -value = .030) and hematologic failure (OR 5.6, 95% CI: 2.2-14.5, P -value = .0003) were significant predictors. In the mPSC excluded subgroup, only renal failure predicted mortality (OR 9.6, 95% CI 1.1-73.0, P -value = .028). Conclusions Further study of the impact of the 2024 data-driven organ dysfunction definition on pediatric sepsis research, patient safety, and clinical benchmarking efforts is warranted.
Institutions: University of Pittsburgh, Children's Hospital of Philadelphia, Children's National, Central Michigan University, Children's Hospital of Michigan, Nationwide Children's Hospital, Abigail Wexner Research Institute, Children's Hospital of Los Angeles, University of Michigan, C. S. Mott Children's Hospital, University of California, Los Angeles, Mattel Children's Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G118545657, G1223667318, G1328420516, G1785755001, Data Coordinating Center for the Collaborative Pediatric Critical Care Research Network, G2613946276, G3796038147, Controlled Trial of Two Lung Protective Ventilation Modes in Acute Lung Injury, G4545402594, G4847285905, G4868884155, Collaborative Pediatric Research Critical Care Network(U10), Pediatric Critical Care Research Network at Children's Hospital of Philadelphia, G6643719109, G6859970654, G7013078830, G7680495992, G781365963, Inflammation Phenotypes in Pediatric Sepsis Induced Multiple Organ Failure Renewal, G904363605, Collaborative Pediatric Critical Care Research Network At Children's Hospital of
OpenAlex ID: W4411354698