1. The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study
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Daniela Carla de Souza, Joelma Gonçalves Martin, Vanessa Soares Lanziotti, Cláudio Flauzino de Oliveira, Cristian Tonial, Werther Brunow de Carvalho, José Roberto Fioretto, Jefferson Pedro Piva, Eduardo Juan Troster, Aline Siqueira Bossa, Flávia Gregorini, Josiane Ferreira, Juliana Lubarino, Alexandre Biasi Cavalcanti, Flávia Ribeiro Machado, SC Silva, J Giacomazzi, Domingos A. Boldrini, FH Gilli, LC de Castro, ML de Albuquerque, VCTG Osorio, MLC Elias, AA da Câmara, M Maia, PB de Carvalho, FM Augusto, RCCM de Figueiredo, EL Ikino, FAS Nogueres, RJ de Almeida, L Torreão, J Ramalho, MMS Camões, CS de Oliveira, VIIS Serafim, J Colleti Junior, CG de Almeida, MHM da Costa, JF Valerio, ME Navajas, PM Riveiro, A Lubiana, ACLC Brito, V Moretto, LMMD Rachid, M Valle, PP de Souza, RPL Victor, NR Castro, T Sakomura, M Molon, AR Ferreira, JG da Fonseca, VCA Cunali, VCA Chagas, G Belek, TS da Rocha, LCFF de Mello, LM Machado, NV Moliterno, C Duran, CLEB Sanos, GT Ribeiro, PSL da Silva, R Lipinski, A Soledade, KC Branco, ACO Teles, GF da Cruz, MR de Mendonça, E Malheiros, J Vicari, PNT Izidro, NMP Campos, TC Pontes, CRF Carneiro, AH Imamura, FM Yoshioka, MCMB Duarte, T Menezes, C Falconiere, F Matos, RS Zeitel, CC Nogueras, ML da Silva, M Aprille, TYM Pires, AF Portella, PVG Flores, PP Alfradique, RC Nascimento, MO Saldanha, AT Alves, WJ de Almeida, M Rodrigues, E Lopes Júnior, MRP Komka, MAR Nascimento, CRC Lopes, TMC Bernardi, RV Falcão, AR Fraga, AA Machado, JEF Godoy, J Barcellos, RLS Queiroz, VVS de Almeida, JZG Lira, M Alvo, TCP Peçanha, AM de Sousa, CS Sanches, AR Wendhausen, SR Pinheiro, MA Orione, AM Minossi, NL Bresolin, CDF Martins, VF Cury, RPB Quinet, AL Netto, R Limonge, SST Tamari, SER de Souza, R Veiga, NGCB Couto, MFP Ribeiro, AK de Aguiar, M Evangelista, JR Krauzer, H Muller, DHS Genu, PA Alvares, KL Maciel, FT Valente, M Centeville, GJ Espinheira, A da Silva, PL Vasconcelos, AZ Hädrich, ALDGC Sousa, GA Gandra, ACA Souto, L Sabatini, PRD João, ABMP Machado, FR Fonseca, APA Resende, RV da Silva, TP da Silva, LLT Barros, CSV de Souza, KO Harada, D Calçado, LSB Pinheiro, MCM Frota, LB Pulcheri, LM e Silva, KJ dos Santos, FH de Nuncio, IO Gomes Júnior, ACC Gomes, MA Klitzke, FR de Souza, FSC Carvalho, FP de Lima, LR Braun Filho, MAG de Oliveira, T Castilho, IP Pistelli, JD Paccez, C Cendon, R Sapolnick, D Fronza, C Toscan, RM Pinelli, JV Alencar, HL di Pace, AD Ramos, AC Molinari, JF Assis, APCR Chavarri, RC Pereira, CL Freitas, ICDM Salmen, RCM Guerini, J Asakura, ACR Pires, G Benvenuti, LM Fernandes, NF Oliveira, HJB Barros, LCE Nascimento, MB Machado, AOR dos Santos, AC da Silva, ACE de Oliveira, SKY Reinheimer, PCS Mello, IO Araújo, KLC Rodrigues, MN Amari, M Andersson, LMCM Petrini, AKSF Luz, ESS Serafim, RF Barbosa, D Souza, AF Delgado, ALP Guerra, JY Afiune, J Huber, S Casonato, DCB da Silva, OR de Araujo, FMD Fialho, LFR Soares, AA de Queiroz Júnior, A Sartorelli, ACP Zuccoli, M Castelani, LAA da Silva, SRA Lima, MJSL de Araújo, ACS da Cruz, PM Sillero, G Sgorlon, TRS Alves, MMB Muniz, RHP Pereira, NR Gonçalves, RPV Teixeira, IA Vasconcelos, CT Rossetti, RG Cesar, MAJ Alves, MK Martins, JAR Rocha, L Arruda, ALY Grillo, and G Barros
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Male ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Prevalence ,Intensive Care Units, Pediatric ,Sepsis ,symbols.namesake ,Epidemiology ,Developmental and Educational Psychology ,medicine ,Humans ,Hospital Mortality ,Poisson regression ,Child ,business.industry ,Septic shock ,Mortality rate ,Infant, Newborn ,Infant ,medicine.disease ,Hospitalization ,Child, Preschool ,Relative risk ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,symbols ,Female ,Observational study ,business ,Brazil - Abstract
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.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.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, p0·0001), 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).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.Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico.For the Portuguese translation of the abstract see Supplementary Materials section.
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- 2021