Modern Diagnostics of Sepsis and Septic Shock in Children

Yekaterina Y. Bulatova; Nurila A. Maltabarova; Murat B. Zhumabayev; Tatyana A. Li; Marina P.  Ivanova

doi:10.3889/oamjms.2020.4554

Authors

Yekaterina Y. Bulatova NJSC “Astana Medical University”, Astana, Kazakhstan
Nurila A. Maltabarova NJSC “Astana Medical University”, Astana, Kazakhstan
Murat B. Zhumabayev NJSC “Astana Medical University”, Astana, Kazakhstan
Tatyana A. Li NJSC “Astana Medical University”, Astana, Kazakhstan
Marina P. Ivanova NJSC “Astana Medical University”, Astana, Kazakhstan

DOI:

https://doi.org/10.3889/oamjms.2020.4554

Keywords:

Sepsis in children, Pediatric sepsis, Septic shock in children, Sepsis diagnostics, Sepsis recognition, Sepsis biomarkers

Abstract

Sepsis is still one of the leading causes of child mortality worldwide, despite advances in its diagnosis and treatment. Difficulties in recognizing the transition of a localized infectious-inflammatory process to a generalized one lead to a belated diagnosis and the beginning of therapy. Meanwhile, the earlier treatment is started, the higher the patients’ chances of life. Early diagnosis of sepsis, which corresponds to modern ideas about this condition, is one of the main tasks for both scientists and practitioners. The aim of this review is to study modern recommendations for the diagnosis of sepsis and septic shock in children. The article reflects the epidemiology, etiological features, modern definitions, and methods of diagnosis of pediatric sepsis.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Dugani S, Kissoon N. Global advocacy needed for sepsis in children. J Infect. 2017;74:S61-5. https://doi.org/10.1016/ s0163-4453(17)30193-7

PMid:28646964

Schlapbach LJ, Straney L, Alexander J, Maclaren G, Festa M, Schibler A, et al. Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: A multicentre retrospective cohort study. Lancet Infect Dis. 2015;15(1):46-54. https://doi.org/10.1016/ s1473-3099(14)71003-5

PMid:25471555

Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, et al. The global burden of paediatric and neonatal sepsis: A systematic review. Lancet Respir Med. 2018;6(3):223-30. https://doi.org/10.1016/ s2213-2600(18)30063-8 PMid:29508706

Ansermino JM, Wiens MO, Kissoon N. We need smarter trigger tools for diagnosing sepsis in children in Canada. CMAJ 2018;190(36):E1060-1. https://doi.org/10.1503/cmaj.180434 PMid:30201612

Conway EE. Pediatric sepsis: A primer for the pediatrician. Pediatr Ann. 2018;47(7):e292-9. https://doi. org/10.3928/19382359-20180620-02 PMid:30001444

Agyeman PK, Schlapbach LJ, Giannoni E, Stocker M, Posfay-Barbe KM, Heininger U, et al. Epidemiology of blood cultureproven bacterial sepsis in children in Switzerland: A populationbased cohort study. Lancet Child Adolesc Health. 2017;1(2):124-33. https://doi.org/10.1016/s2352-4642(17)30010-x

Yang J, Zhang S, Zhang J, Dong J, Wu J, Zhang L, et al. Identification of key genes and pathways using bioinformatics analysis in septic shock children. Infect Drug Resist. 2018;11:1163-74. https://doi.org/10.2147/idr.s157269 PMid:30147344

Wong HR. Genetics and genomics in pediatric septic shock. Crit Care Med. 2012;40(5):1618-26. PMid:22511139

Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762-74. https://doi. org/10.1001/jama.2016.0288

Bradshaw C, Goodman I, Rosenberg R, Bandera C, Fierman A, Rudy B. Implementation of an inpatient pediatric sepsis identification pathway. Pediatrics. 2016;137(3):e20144082. https://doi.org/10.1542/peds.2014-4082

Ames SG, Davis BS, Angus DC, Carcillo JA, Kahn JM. Hospital variation in risk-adjusted pediatric sepsis mortality. Pediatr Crit Care Med. 2018;19(5):390-6. https://doi.org/10.1097/ pcc.0000000000001502 PMid:29461429

Mathias B, Mira JC, Larson SD. Pediatric sepsis. Curr Opin Pediatr. 2016;28(3):380-7. https://doi.org/10.1164/ rccm.201412-2323oc PMid:26983000

Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A, et al. Global epidemiology of pediatric severe sepsis: The sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015;191(10):1147-57. PMid:25734408

Plunkett A, Tong J. Sepsis in children. BMJ. 2015;350:h3017. https://doi.org/10.1136/bmj.h3017 PMid:26060188

Souza DC, Brandão MB, Piva JP. From the international pediatric sepsis conference 2005 to the sepsis-3 consensus. Rev Bras Terapia Intensiva. 2018;30(1):1-5. https://doi. org/10.5935/0103-507x.20180005 PMid:29742230

de Souza D, Machado F. Epidemiology of pediatric septic shock. J Pediatr Intens Care. 2019;8(1):3-10. PMid:31073502

Tan B, Wong JJ, Sultana R, Koh JC, Jit M, Mok YH, et al. Global case-fatality rates in pediatric severe sepsis and septic shock: A systematic review and meta-analysis. JAMA Pediatr. 2019;173(4):352-61. https://doi.org/10.1001/ jamapediatrics.2018.4839 PMid:30742207

The Ministry of Health Care of the Republic of Kazakhstan. The Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations in 2017. Statistical Digest. Astana: Republic of Kazakhstan; 2018. https://doi. org/10.32014/2018.2518-1629.2

Boeddha NP, Schlapbach LJ, Driessen GJ, Herberg JA, Rivero-Calle I, Cebey-López M, et al. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: A prospective cohort study from the European childhood life-threatening infectious disease study (EUCLIDS). Crit Care. 2018;22(1):143. https://doi.org/10.1186/s13054-018-2052-7 PMid:29855385

Hasan GM, Al-Eyadhy AA, Temsah MH, Al-Haboob AA, Alkhateeb MA, Al-Sohime F. Feasibility and efficacy of sepsis management guidelines in a pediatric intensive care unit in Saudi Arabia: A quality improvement initiative. Int J Qual Health Care. 2018;30(8):587-93. https://doi.org/10.1093/intqhc/ mzy077

Prout AJ, Talisa VB, Carcillo JA, Mayr FB, Angus DC, Seymour CW, et al. Children with chronic disease bear the highest burden of pediatric sepsis. J Pediatr. 2018;199:194-9. https://doi.org/10.1016/j.jpeds.2018.03.056 PMid:29753542

Ruth A, McCracken CE, Fortenberry JD, Hall M, Simon HK, Hebbar KB. Pediatric severe sepsis: Current trends and outcomes from the pediatric health information systems database. Pediatr Crit Care Med. 2014;15(9):828-38. https:// doi.org/10.1097/pcc.0000000000000254 PMid:25226500

Kuo KC, Yeh YC, Chiu IM, Tang KS, Su CM, Huang YH. The clinical features and therapy of community-acquired gram negative bacteremia in children less than three years old. Pediatr Neonatol. 2019;61(1):51-7. https://doi.org/10.1016/j. pedneo.2019.05.009 PMid:31257100

Gupta N, Richter R, Robert S, Kong M. Viral sepsis in children. Front Pediatr. 2018;6:252. PMid:30280095 25. Mendez RL. Sepsis in children. Pediatr Int. 2000;42(5):528-33. PMid:11059544

Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med. 2013;14(7):686-93. https://doi.org/10.1097/ pcc.0b013e3182917fad PMid:23897242

Weiss SL, Deutschman CS. Are septic children really just “septic little adults”? Intensive Care Med. 2018;44(3):392-4. https://doi. org/10.1007/s00134-017-5041-4 PMid:29356850

Simpson SQ. SIRS in the time of sepsis-3. Chest. 2018;153(1):34-8. PMid:29037526

Sankar J, Dhochak N, Kumar K, Singh M, Sankar MJ, Lodha R. Comparison of international pediatric sepsis consensus conference versus sepsis-3 definitions for children presenting with septic shock to a tertiary care center in India: A retrospective study. Pediatr Crit Care Med. 2019;20(3):E122-9. https://doi. org/10.1097/pcc.0000000000001864 PMid:30640887

Wang Y, Lin X, Yue H, Kissoon N, Sun B. Evaluation of systemic inflammatory response syndrome-negative sepsis from a Chinese regional pediatric network 11 medical and health sciences 1103 clinical sciences. BMC Pediatr. 2019;19(1):11. https://doi.org/10.1186/s12887-018-1364-8 PMid:30621637

Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8. https://doi.org/10.1097/01.pcc.0000149131.72248.e6 PMid:15636651

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012. Crit Care Med 2013;41:580-637. https://doi.org/10.1007/ s00134-012-2769-8 PMid:23353941

Emr BM, Alcamo AM, Carcillo JA, Aneja RK, Mollen KP. Pediatric sepsis update: How are children different? Surg Infect. 2018;19(2):176-83. https://doi.org/10.1089/sur.2017.316 PMid:29394150

Wheeler DS, Wong HR, Zingarelli B. Pediatric sepsis Part I: Children are not small adults. Open Inflamm J. 2011;4:4-15. PMid:23723956

Wheeler DS. Introduction to pediatric sepsis. Open Inflamm J. 2011;4 Suppl 1:1-3. PMid:25285177

Horeczko T, Green JP. Emergency department presentation of the pediatric systemic inflammatory response syndrome. Pediatr Emer Care. 2013;29(11):1153-8. https://doi.org/10.1097/ pec.0b013e3182a9e629 PMid:24168885

Zhumabayev M, Maltabarova N, Kokoshko A. A cerebralstroke and the problem of inflammatory complications. Res J Med Sci. 2016;10(5):492-7.

Schlapbach LJ, Straney L, Bellomo R, MacLaren G, Pilcher D. Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit. Intens Care Med. 2018;44(2):179-88. https://doi.org/10.1007/ s00134-017-5021-8 PMid:29256116

Schlapbach LJ. Paediatric sepsis. Curr Opin Infect Dis. 2019; 32(5):497-504.

Peters C, Murthy S, Brant R, Kissoon N, Görges M. Mortality risk using a pediatric quick sequential (sepsis-related) organ failure assessment varies with vital sign thresholds. Pediatr Crit Care Med.2018;19(8):e394-402. https://doi.org/10.1097/ pcc.0000000000001598 PMid:29939978

Morin L, Ray S, Wilson C, Remy S, Benissa MR, Jansen NJ, et al. Refractory septic shock in children: a European society of paediatric and neonatal intensive care definition. Intens Care Med.2016;42(12):1948-57. https://doi.org/10.1007/ s00134-016-4574-2 PMid:27709263

Hofer N, Zacharias E, Müller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: Current insights and new tasks. Neonatology. 2012;102(1):25-36. https://doi.org/10.1159/000336629 PMid:22507868

Martinez R, Rode H. Role of procalcitonin in paediatric burn wound sepsis. S Afr Med J. 2018;108(10):793-4. https://doi. org/10.7196/samj.2018.v108i10.13515 PMid:3042170

Basaranoglu ST, Karadag-Oncel E, Aykac K, Ozsurekci Y, Aycan AE, Cengiz AB, et al. Presepsin: A new marker of catheter related blood stream infections in pediatric patients. J Infect Chemother. 2018;24(1):25-30. https://doi.org/10.1016/j. jiac.2018.04.008 PMid:28919353

El Gendy FM, El-Mekkawy MS, Saleh NY, Habib MS, Younis FE. Clinical study of presepsin and pentraxin3 in critically ill children. J Crit Care. 2018;47:36-40. https://doi.org/10.1016/j. jcrc.2018.06.004 PMid:29886065

Yoon SH, Kim EH, Kim HY, Ahn JG. Presepsin as a diagnostic marker of sepsis in children and adolescents: A systemic review and meta-analysis. BMC Infect Dis. 2019;19(1):760. https://doi. org/10.1186/s12879-019-4397-1 PMid:31470804

Weidhase L, Wellhöfer D, Schulze G, Kaiser T, Drogies T, Wurst U, et al. Is interleukin-6 a better predictor of successful antibiotic therapy than procalcitonin and C-reactive protein? A single center study in critically ill adults. BMC Infect Dis. 2019;19(1):150. https://doi.org/10.1186/s12879-019-3800-2 PMid:30760225

Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, Osborn TM, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: Results from the Surviving Sepsis Campaign database. Crit Care Med. 2015;43(3):567-73. https:// doi.org/10.1097/ccm.0000000000000742 PMid:25479113

Schuh AM, Leger KJ, Summers C, Uspal NG. Lactic acidosis in a critically Ill patient: Not always sepsis. Pediatr Emerg Care. 2018;34(9):e165-7. https://doi.org/10.1097/ pec.0000000000001603 PMid:30180106

Jacobs L, Berrens Z, Stenson EK, Zackoff MW, Danziger LA, Lahni P, et al. The pediatric sepsis biomarker risk model (PERSEVERE) biomarkers predict clinical deterioration and mortality in immunocompromised children evaluated for infection. Sci Rep.2019;9(1):1-8. https://doi.org/10.1038/ s41598-018-36743-z

Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, et al. Improved risk stratification in pediatric septic shock using both protein and mRNA biomarkers: Persevere-XP. Am J Respir Crit Care Med. 2017;196(4):494-501. https://doi. org/10.1164/rccm.201701-0066oc PMid:28324661

Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, et al. Pediatric sepsis biomarker risk model-II: Redefining the pediatric sepsis biomarker risk model with septic shock phenotype. Crit Care Med. 2016;44(11):2010-7. https:// doi.org/10.1016/j.jemermed.2016.12.022 PMid:27513537

Dursun A, Ozsoylu S, Akyildiz BN. Neutrophil-to-lymphocyte ratio and mean platelet volume can be useful markers to predict sepsis in children. Pak J Med Sci. 2018;34(4):918-22. https:// doi.org/10.12669/pjms.344.14547

Gupta S, Alam A. Shock index-a useful noninvasive marker associated with age-specific early mortality in children with severe sepsis and septic shock: Age-specific shock index cutoffs. J Intens Care Med. 2018;2:885066618802779. https://doi. org/10.1177/0885066618802779 PMid:30278814

Sharma A, Sikka M, Gomber S, Sharma S. Plasma fibrinogen and D-dimer in children with sepsis: A single-center experience. Iran J Pathol. 2018;13(2):272-5. https://doi.org/10.30699/ ijp.13.2.272 PMid:30697298

Piva JP, Garcia PC, Da Rocha TS. Hypofibrinogenemia and pediatric sepsis: Another piece of the puzzle! Pediatr Crit Care Med. 2018;19(5):491-2. https://doi.org/10.1097/ pcc.0000000000001514 PMid:29727417

Cabrita A, Pinheiro J, Falcão LM. Rethinking the concept of sepsis and septic shock. Eur J Intern Med. 2018;54:1-5. PMid:29921471

Excellence C. Sepsis: Recognition, diagnosis and early management. BJU Int. 2018;121(4):497-514. https://doi. org/10.1111/bju.14179

Hébert A, Boucher MP, Guimont C, Weiss M. Effect of measuring vital signs on recognition and treatment of septic children. Paediatr Child Health. 2017;22(1):13-6. https://doi.org/10.1093/ pch/pxw003 PMid:29483789

Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Med. 2019;7:205031211983504. https://doi. org/10.1177/2050312119835043 PMid:30915218

Li TA, Maltabarova NA, Kussaev YM, Yermekov JM. Bronchopulmonary dysplasia at children. Ann Trop Med Public Health Special Issue. 2018;17:62-8.