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

Objectives: To evaluate the proportion of children fulfilling “Sepsis-3” definition and International Pediatric Sepsis Consensus Conference definition among children diagnosed to have septic shock and compare the mortality risk between the two groups. Design: Retrospective chart review. Setting: PICU of a tertiary care teaching hospital from 2014 to 2017. Patients: Children (≤ 17 yr old) with a diagnosis of septic shock at admission or during PICU stay. Interventions: None. Measurements and Main Results: We applied both International Pediatric Sepsis Consensus Conference and the new “Sepsis-3” definition (sepsis with hypotension requiring vasopressors and a lactate value of ≥ 2 mmol/L) to identify cases of septic shock by these definitions. Key outcomes such as mortality, proportion attaining shock reversal at 24 hours and organ dysfunction were compared between those fulfilling “Sepsis-3” definitions (“Sepsis-3” group) and those fulfilling “International Pediatric Sepsis Consensus Conference” definition (“International Pediatric Sepsis Consensus Conference” group). A total of 216 patients fulfilled International Pediatric Sepsis Consensus Conference definitions of septic shock. Of these, only 104 (48%; 95% CI, 42–55) fulfilled “Sepsis-3” definition. Children fulfilling “Sepsis-3 plus International Pediatric Sepsis Consensus Conference definitions” (“Sepsis-3 and International Pediatric Sepsis Consensus Conference” group) had lower proportion with shock resolution (61% vs 82%; relative risk, 0.73; 95% CI, 0.62–0.88) and higher risk of multiple organ dysfunction (85% vs 68%; 1.24; 1.07–1.45) at 24 hours. The mortality was 48.5% in “Sepsis-3 and International Pediatric Sepsis Consensus Conference” group as compared with 37.5% in the “International Pediatric Sepsis Consensus Conference only” group (relative risk, 1.3; 95% CI, 0.94–1.75). Conclusions: Less than half of children with septic shock identified by International Pediatric Sepsis Consensus Conference definitions were observed to fulfill the criteria for shock as per “Sepsis-3” definitions. Lack of difference in the risk of mortality between children who fulfilled “Sepsis-3” definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of septic shock in children. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://bit.ly/2gIrZ5Y). The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: jhumaji@gmail.com ©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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