Clinical outcomes after utilizing surviving sepsis campaign in children with septic shock and prognostic value of initial plasma NT-proBNP

• Published in: Indian journal of critical care medicine Vol. 18; no. 2; pp. 70 - 76
• Main Authors: Samransamruajkit, Rujipat, Uppala, Rattapon, Pongsanon, Khemmachart, Deelodejanawong, Jitladda, Sritippayawan, Suchada, Prapphal, Nuanchan
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-02-2014; Jaypee Brothers Medical Publishers Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Care and treatment; Children; Clinical outcomes; Diseases; Hospitals; Infections; Mortality; Patient outcomes; Plasma; Practice guidelines (Medicine); Sepsis; SSC guideline; surviving sepsis campaign; Biomarker; pediatric sepsis; severe sepsis; mortality; decrease mortality
• ISSN: 0972-5229; 1998-359X
• DOI: 10.4103/0972-5229.126075

The surviving sepsis campaign treatment guideline (SSC) implementation is associated with improved outcome in adults with severe sepsis. The effect on outcome of pediatric sepsis is less clear.
To determine the clinical outcomes of SSC implementation and to investigate the prognostic value of initial plasma NT-proBNP and procalcitonin in children.
Infants and children (aged 1month/0-15 years with severe sepsis or septic shock) were prospectively enrolled and treated according to the guidelines. Initial blood drawn was saved for NT-pro-BNP, procalcitonin measurements and clinical data were also recorded.
A total of 47 subjects were recruited. Since the application of the SSC, our mortality rate had significantly decreased from 42-19% (P = 0.003) as compared to the data in the previous 3 years. Clinical factors that significantly increased the mortality rate were: Initial central venous oxygen saturation < 7 0% after fluid resuscitation [odds ratio (OR) = 23.3; 95% confidence interval (CI) 3.7-143; P = 0.001], and initial albumin level (≤ 3 g/dl, OR = 6.7; 95% CI 1.2-37.5, P = 0.03). There was asignificant difference between the initial NT-proBNP levels between survivors and non survivors, (6280.3 ± 9597 ng/L, P < 0.001), but not for procalcitonin (12.7 ± 24.8, 29.3 ± 46 μg/L, P = 0.1), respectively. An initial NT-proBNP level of more than 11,200 pg/ml predicted Pediatric Intensive Care Unit (PICU) mortality with a sensitivity of 85.7% and a specificity of 90%.
A modified SSC for severe sepsis and septic shock significantly reduced the mortality rate in our PICU. High initial NT-ProBNP level was associated with mortality.