Background

Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality.

Methods

We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates.

Findings

Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6–28·8), with a mortality rate of 19·8% (15·4–25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14–1·29, p<0·0001), unknown vaccination status (2·57, 1·26–5·24; p=0·011), incomplete vaccination status (2·16, 1·19–3·92; p=0·012), health care-associated infection (2·12, 1·23–3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46–3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5–90·5), which translates to 42 374 cases per year (34 940–51 443) in Brazil, with an estimated mortality of 8305 (6848–10 083).

Interpretation

In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality.

Funding

Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico.

Translation

For the Portuguese translation of the abstract see Supplementary Materials section.

中文翻译：

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巴西儿科重症监护病房脓毒症的流行病学（儿科人群脓毒症患病率评估数据库，SPREAD PED）：一项观察性研究

背景

关于资源贫乏地区儿科脓毒症患病率和死亡率的数据很少。我们旨在评估在巴西儿科重症监护病房 (PICU) 中治疗的严重脓毒症和感染性休克的患病率和院内死亡率，以及死亡率的危险因素。

方法

我们使用巴西所有 PICU 的分层随机样本进行了一项全国性、为期 1 天的前瞻性点流行率研究，并对严重脓毒症和脓毒性休克患者进行了随访。患者在 2019 年 3 月 25 日至 29 日期间的一天内在每个参与的 PICU 登记。所有在研究日（之前入院或当天入院）在 PICU 占用一张床的患者都包括在内，如果他们的年龄为 28 天至 18 岁年，并且在住院期间的任何时间都符合严重脓毒症或脓毒性休克的标准。随访患者直至出院或死亡，在 60 天时进行审查。使用泊松回归模型评估死亡率的危险因素。我们使用流行率来生成国家估计。

发现

在受邀参与的 241 个 PICU 中，144 个 PICU（可容纳 1242 张床位）包括患者参与研究。在研究当天，1122 名儿童入住参与的 PICU，其中 280 名在住院期间符合严重脓毒症或感染性休克的标准，患病率为 25·0%（95% CI 21·6-28· 8)，死亡率为 19·8%（15·4–25·2；252 名具有完整临床数据的患者中的 50 名）。死亡风险的增加与较高的儿科顺序器官衰竭评估评分（每点的相对风险增加 1·21，95% CI 1·14–1·29，p<0·0001）、未知的疫苗接种状态（2·57， 1·26–5·24；p=0·011），不完全接种状态（2·16，1·19-3·92；p=0·012），医疗相关感染（2·12，1· 23-3·64，p=0·0073），以及对抗生素的依从性（2·38，1·46-3·86，p=0·0007）。

解释

在这个中等收入国家的 PICU 代表性样本中，严重脓毒症或感染性休克的患病率和院内死亡率很高。可改变的因素，如疫苗接种不完全和医疗保健相关感染，与更大的院内死亡率风险相关。

资金

Fundação de Amparo à Pesquisa do Estado de São Paulo 和 Conselho Nacional de Desenvolvimento Científico e Tecnológico。

翻译

有关摘要的葡萄牙语翻译，请参阅补充材料部分。