Madhuradhar Chegondi, MD
Clinical Associate Professor, Division of Pediatric Critical Care Medicine
University of Iowa Stead Family Childrens's Hospital
Iowa City, IA, United States
Disclosure information not submitted.
Janelle Buysse
Pediatric Cardiology Fellow
University of Iowa Stead Family Childrens's Hospital
Iowa City, IA
Disclosure information not submitted.
Harsh Kothari, MD
Clinical Assistant Professor
Dayton Children's Hospital
Dayton, Ohio, United States
Disclosure information not submitted.
Aditya Badheka, MD, MS
Clinical Associate Professor, Pediatric Critical Care
University of Iowa Hospital and Clinics
Iowa City, Iowa, United States
Disclosure information not submitted.
Ravi Ashwath, MD
Clinical Professor, Pediatric Cardiology
Stead Family Children's Hospital, University of Iowa, United States
Disclosure information not submitted.
Patrick Mc Namara, MD
Professor of Pediatrics- Neonatology
Stead Family Children's Hospital, University of Iowa, United States
Disclosure information not submitted.
Title: Echocardiographic Predictors of Mortality in the setting of Pediatric Septic Shock
Introduction: Sepsis is the leading cause of death in children. A subset of patients who develop shock represents the most severe form and accounts for 25% mortality. Cardiovascular dysfunction is the principal mechanism in septic shock. Hemodynamic assessment is complicated by variance in clinical presentation resulting in increased echocardiography (ECHO) use recently. No prior studies have evaluated the relationship of ECHO markers to mortality risk.
Methods: A retrospective study of children 1 month to 18 years of age with septic shock admitted to the pediatric ICU from 2015 to 2019. The primary aim was to compare ECHO markers between survivors and non-survivors. We used ICD-9 & 10 diagnostic codes to identify patients with sepsis and septic shock. Data retrieved using electronic medical records. Demographic, diagnostic, laboratory, ECHO markers including LV ejection fraction, fractional shortening, LV end-diastolic volume and size, RV size, mitral E/A ratio, aortic peak velocity, and IVC diameter and outcome data. We selected ECHOs that were done during the acute resuscitative phase. Analysis was summarized using descriptive statistics and Mann-Whitney test to compare ECHO data. In addition, regression analysis for the primary outcome of death was performed.
Results: A total of 120 children with septic shock were identified. Among them 50 (41.6%) children who had ECHO performed during the resuscitation, 14 (28%) died. There was no difference in gender, age at presentation, or body mass index between groups. Net fluid balance at 24 hours of admission was lower among non-survivors [814 ml (439-2492) vs. 1379 ml (364-3378); p=0.01]. PIM-3 risk of mortality score was also different between groups [4.9 (1-18.4) vs. 3.3 (1.4-11); p=0.001]. Although not statistically significant, a 4-fold increase in the incidence of RV dysfunction was noted in non-survivors, but no differences in other ECHO markers were noted. Net fluid balance remained associated with mortality after adjustment for illness severity score.
Conclusions: Net fluid balance and illness severity score were associated with mortality in children with septic shock, but no reliable ECHO markers were identified. Low rate of ECHO evaluation and the lack of longitudinal evaluation are major limitations that may be addressed in a prospective study.