Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study

Luregn J Schlapbach, Lahn David John Straney, Janet Alexander, Graeme MacLaren, Marino Festa, Andreas Schibler, Anthony Slater

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Abstract

Background Severe infections kill more than 4?5 million children every year. Population-based data for severe infections in children requiring admission to intensive care units (ICUs) are scarce. We assessed changes in incidence and mortality of severe infections in critically ill children in Australia and New Zealand. Methods We did a retrospective multicentre cohort study of children requiring intensive care in Australia and New Zealand between 2002 and 2013, with data from the Australian and New Zealand Paediatric Intensive Care Registry. We included children younger than 16 years with invasive infection, sepsis, or septic shock. We assessed incidence and mortality in the ICU for 2002?07 versus 2008?13. Findings During the study period, 97 127 children were admitted to ICUs, 11 574 (11?9 ) had severe infections, including 6688 (6?9 ) with invasive infections, 2847 (2?9 ) with sepsis, and 2039 (2?1 ) with septic shock. Age-standardised incidence increased each year by an average of 0?56 cases per 100 000 children (95 CI 0?41?0?71) for invasive infections, 0?09 cases per 100 000 children (0?00?0?17) for sepsis, and 0?08 cases per 100 000 children (0?04?0?12) for septic shock. 260 (3?9 ) of 6688 patients with invasive infection died, 159 (5?6 ) of 2847 with sepsis died, and 346 (17?0 ) of 2039 with septic shock died, compared with 2893 (3?0 ) of all paediatric ICU admissions. Children admitted with invasive infections, sepsis, and septic shock accounted for 765 (26?4 ) of 2893 paediatric deaths in ICUs. Comparing 2008?13 with 2002?07, risk-adjusted mortality decreased significantly for invasive infections (odds ratio 0?72, 95 CI 0?56?0?94; p=0?016), and for sepsis (0?66, 0?47?0?93; p=0?016), but not significantly for septic shock (0?79, 0?61?1?01; p=0?065). Interpretation Severe infections remain a major cause of mortality in paediatric ICUs, representing a major public health problem. Future studies should focus on patients with the highest risk of poor outcome, and assess the effectiveness of present sepsis interventions in children.
Original languageEnglish
Pages (from-to)46 - 54
Number of pages9
JournalLancet Infectious Diseases
Volume15
Issue number1
DOIs
Publication statusPublished - 2015

Cite this

Schlapbach, Luregn J ; Straney, Lahn David John ; Alexander, Janet ; MacLaren, Graeme ; Festa, Marino ; Schibler, Andreas ; Slater, Anthony. / Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study. In: Lancet Infectious Diseases. 2015 ; Vol. 15, No. 1. pp. 46 - 54.
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title = "Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study",
abstract = "Background Severe infections kill more than 4?5 million children every year. Population-based data for severe infections in children requiring admission to intensive care units (ICUs) are scarce. We assessed changes in incidence and mortality of severe infections in critically ill children in Australia and New Zealand. Methods We did a retrospective multicentre cohort study of children requiring intensive care in Australia and New Zealand between 2002 and 2013, with data from the Australian and New Zealand Paediatric Intensive Care Registry. We included children younger than 16 years with invasive infection, sepsis, or septic shock. We assessed incidence and mortality in the ICU for 2002?07 versus 2008?13. Findings During the study period, 97 127 children were admitted to ICUs, 11 574 (11?9 ) had severe infections, including 6688 (6?9 ) with invasive infections, 2847 (2?9 ) with sepsis, and 2039 (2?1 ) with septic shock. Age-standardised incidence increased each year by an average of 0?56 cases per 100 000 children (95 CI 0?41?0?71) for invasive infections, 0?09 cases per 100 000 children (0?00?0?17) for sepsis, and 0?08 cases per 100 000 children (0?04?0?12) for septic shock. 260 (3?9 ) of 6688 patients with invasive infection died, 159 (5?6 ) of 2847 with sepsis died, and 346 (17?0 ) of 2039 with septic shock died, compared with 2893 (3?0 ) of all paediatric ICU admissions. Children admitted with invasive infections, sepsis, and septic shock accounted for 765 (26?4 ) of 2893 paediatric deaths in ICUs. Comparing 2008?13 with 2002?07, risk-adjusted mortality decreased significantly for invasive infections (odds ratio 0?72, 95 CI 0?56?0?94; p=0?016), and for sepsis (0?66, 0?47?0?93; p=0?016), but not significantly for septic shock (0?79, 0?61?1?01; p=0?065). Interpretation Severe infections remain a major cause of mortality in paediatric ICUs, representing a major public health problem. Future studies should focus on patients with the highest risk of poor outcome, and assess the effectiveness of present sepsis interventions in children.",
author = "Schlapbach, {Luregn J} and Straney, {Lahn David John} and Janet Alexander and Graeme MacLaren and Marino Festa and Andreas Schibler and Anthony Slater",
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Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study. / Schlapbach, Luregn J; Straney, Lahn David John; Alexander, Janet; MacLaren, Graeme; Festa, Marino; Schibler, Andreas; Slater, Anthony.

In: Lancet Infectious Diseases, Vol. 15, No. 1, 2015, p. 46 - 54.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study

AU - Schlapbach, Luregn J

AU - Straney, Lahn David John

AU - Alexander, Janet

AU - MacLaren, Graeme

AU - Festa, Marino

AU - Schibler, Andreas

AU - Slater, Anthony

PY - 2015

Y1 - 2015

N2 - Background Severe infections kill more than 4?5 million children every year. Population-based data for severe infections in children requiring admission to intensive care units (ICUs) are scarce. We assessed changes in incidence and mortality of severe infections in critically ill children in Australia and New Zealand. Methods We did a retrospective multicentre cohort study of children requiring intensive care in Australia and New Zealand between 2002 and 2013, with data from the Australian and New Zealand Paediatric Intensive Care Registry. We included children younger than 16 years with invasive infection, sepsis, or septic shock. We assessed incidence and mortality in the ICU for 2002?07 versus 2008?13. Findings During the study period, 97 127 children were admitted to ICUs, 11 574 (11?9 ) had severe infections, including 6688 (6?9 ) with invasive infections, 2847 (2?9 ) with sepsis, and 2039 (2?1 ) with septic shock. Age-standardised incidence increased each year by an average of 0?56 cases per 100 000 children (95 CI 0?41?0?71) for invasive infections, 0?09 cases per 100 000 children (0?00?0?17) for sepsis, and 0?08 cases per 100 000 children (0?04?0?12) for septic shock. 260 (3?9 ) of 6688 patients with invasive infection died, 159 (5?6 ) of 2847 with sepsis died, and 346 (17?0 ) of 2039 with septic shock died, compared with 2893 (3?0 ) of all paediatric ICU admissions. Children admitted with invasive infections, sepsis, and septic shock accounted for 765 (26?4 ) of 2893 paediatric deaths in ICUs. Comparing 2008?13 with 2002?07, risk-adjusted mortality decreased significantly for invasive infections (odds ratio 0?72, 95 CI 0?56?0?94; p=0?016), and for sepsis (0?66, 0?47?0?93; p=0?016), but not significantly for septic shock (0?79, 0?61?1?01; p=0?065). Interpretation Severe infections remain a major cause of mortality in paediatric ICUs, representing a major public health problem. Future studies should focus on patients with the highest risk of poor outcome, and assess the effectiveness of present sepsis interventions in children.

AB - Background Severe infections kill more than 4?5 million children every year. Population-based data for severe infections in children requiring admission to intensive care units (ICUs) are scarce. We assessed changes in incidence and mortality of severe infections in critically ill children in Australia and New Zealand. Methods We did a retrospective multicentre cohort study of children requiring intensive care in Australia and New Zealand between 2002 and 2013, with data from the Australian and New Zealand Paediatric Intensive Care Registry. We included children younger than 16 years with invasive infection, sepsis, or septic shock. We assessed incidence and mortality in the ICU for 2002?07 versus 2008?13. Findings During the study period, 97 127 children were admitted to ICUs, 11 574 (11?9 ) had severe infections, including 6688 (6?9 ) with invasive infections, 2847 (2?9 ) with sepsis, and 2039 (2?1 ) with septic shock. Age-standardised incidence increased each year by an average of 0?56 cases per 100 000 children (95 CI 0?41?0?71) for invasive infections, 0?09 cases per 100 000 children (0?00?0?17) for sepsis, and 0?08 cases per 100 000 children (0?04?0?12) for septic shock. 260 (3?9 ) of 6688 patients with invasive infection died, 159 (5?6 ) of 2847 with sepsis died, and 346 (17?0 ) of 2039 with septic shock died, compared with 2893 (3?0 ) of all paediatric ICU admissions. Children admitted with invasive infections, sepsis, and septic shock accounted for 765 (26?4 ) of 2893 paediatric deaths in ICUs. Comparing 2008?13 with 2002?07, risk-adjusted mortality decreased significantly for invasive infections (odds ratio 0?72, 95 CI 0?56?0?94; p=0?016), and for sepsis (0?66, 0?47?0?93; p=0?016), but not significantly for septic shock (0?79, 0?61?1?01; p=0?065). Interpretation Severe infections remain a major cause of mortality in paediatric ICUs, representing a major public health problem. Future studies should focus on patients with the highest risk of poor outcome, and assess the effectiveness of present sepsis interventions in children.

UR - http://www.sciencedirect.com/science/article/pii/S1473309914710035

U2 - 10.1016/S1473-3099(14)71003-5

DO - 10.1016/S1473-3099(14)71003-5

M3 - Article

VL - 15

SP - 46

EP - 54

JO - Lancet Infectious Diseases

JF - Lancet Infectious Diseases

SN - 1473-3099

IS - 1

ER -