Factors significantly associated with death among pediatric septic shock patients in a resource-limited setting

Abstract

Septic shock is a life-threatening condition. However, there is little data from developing countries regarding the epidemiology and factors associated with death in pediatric septic shock patients. In this study we aimed to determine the epidemiology and factors associated with death in pediatric septic shock patients at Siriraj Hospital, Bangkok, Thailand in order to help physicians identify patients at greater risk of dying so they can be monitored more closely. We retrospectively reviewed the charts of all patients aged 1 month to 18 years admitted to the pediatric intensive care unit at the study hospital during January 2013-December 2017. Factors recorded from the charts included demographic characteristics, the Pediatric Risk of Mortality (PRISM) III score, site of infection and therapeutic interventions. The data were examined and multivariable logistic regression analysis was used to determine the factors significantly associated with in-hospital mortality. A total of 94 subjects were included in the study; 48% male. The median (interquartile range (IQR)) age of study subjects was 7.5 (1.2-12.3) years, the in-hospital mortality rate was 33% and the median (IQR) PRISM III score was 11.5 (5.0-19.0). On multivariate analysis, the factors significantly associated with in-hospital mortality were age <1 year (adjusted odds ratio (aOR): 36.5; 95% confidence interval (CI): 3.03-441.03; p=0.005) and a PRISM III score ≥14 (aOR: 54.68; 95%CI: 5.70-524.78; p=0.001). In summary, the mortality rate from septic shock among our subjects was high. Age <1 year and PRISM score ≥14 were significantly associated with death. These patients should be monitored more closely. Further studies are needed to determine what modifications can reduce the risk of mortality in subjects with these factors.