Mortality rate and predictors of mortality of pediatric sepsis and septic shock in a Moroccan tertiary care center

Résumé

Background Sepsis is the leading cause of child mortality worldwide. Pediatric sepsis-related mortality in Africa is estimated to be as high as 40%. We aimed to assess sepsis-related mortality and to identify predictors of mortality in pediatric sepsis. Methods We conducted a retrospective observational study of children admitted to the PICU for sepsis or septic shock. Statistical analysis was performed using Jamovi version 2.3.28. Continuous variables are expressed as mean ± standard deviation (SD) and categorical variables as frequencies and percentages. The Mann–Whitney U test assessed the association between the pediatric sequential sepsis-related organ failure assessment “pSOFA” score and mortality. Logistic regression was used to identify mortality predictors. Model performance was assessed based on discrimination and calibration. Statistical significance was set at p < 0.05. Results We enrolled 130 patients. The mean age was 32.5 months (SD: 47.12, range: 1–180). The identified infection sites were pneumonia (53.1%), central nervous system (23.8%), gastrointestinal tract (15.4%), bloodstream (4.5%), bone and joint (2.3%), and urinary tract (0.8%). Biological assessment showed the following mean values: 14,076 E/mm 3 for leukocytes (SD: 9,162, range: 350–59,100), 349 x 10 3 E/mm 3 for platelets (SD: 214, range: 10–939) and 111 mg/L for C-reactive protein “CRP” (SD 122, range:1–480). The median pSOFA score was six (range: 2–18). A microorganism was isolated in 32.3% of cases, including SARS-CoV-2 (5.2%), Streptococcus pneumoniae (3.7%), respiratory syncytial virus (3%), and Pseudomonas aeruginosa (2.3%). The overall mortality rate was 50%. Statistical analysis showed an association between the pSOFA score and mortality ( p < 0.001). Lower platelet count, vasopressor use, and mechanical ventilation were independently associated with mortality. The logistic regression model performed well with a p -value < 0.001 and a McFadden R 2 of 0.415. The area under the ROC curve was 0.888. The sensitivity, specificity, and accuracy were 88.9%, 85.1%, and 87.0%, respectively, with acceptable calibration. Conclusion Our research assessed pediatric sepsis in Morocco, a lower-middle-income North African country. Mortality rates were higher compared to high-income countries. The pSOFA score was effective in predicting severity and mortality. Lower platelet count, vasopressor use, and mechanical ventilation were identified as independent predictors of mortality.

Citer ce document

Accès au document

Texte intégral en lecture en ligne, réservé aux abonnés SPHAERO et aux membres de l'institution. Se connecter

Auteur(s)

Statistiques

Consultations : 1

Téléchargements : 0