Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

Abstract Background Sepsisis a leading cause of morbidity and mortality after surgery. Most studies regarding sepsisdo not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatricpostsurgical sepsis. Our hypothesis is pediatricpostsurgical, and medical patients with severe sepsishave unique risk factors for mortality. Methods Data were extracted from a secondary analysis of an international point prevalence study of pediatricsevere sepsis. Sites included 128 pediatric intensive care unitsfrom 26 countries. Pediatricpatients with severe sepsiswere categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsisonset. Multivariable logistic regression models were used to determine risk factors for mortality. Results A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndromeat sepsisrecognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndromeat sepsisrecognition, higher PediatricIndex of Mortality-3 score, and malignancy were independent risk factors for death. Conclusions Pediatricpatients with postsurgical sepsishad different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systemsspecific to pediatric sepsisin the postsurgical population.