A BSTRACT Background: Dysregulated host response to infection is sepsis, which is widely recognized as a global public health concern. Severe sepsis along with septic shock in admitted children accounts for 1% to 26%. The mortality rate due to sepsis and its complications in developing countries is high when compared to developed countries. About two-thirds of admissions to the pediatric intensive care unit (PICU) is contributed by sepsis. Septic shock leads to organ failure and increases mortality. Assessing organ failure using both clinical and laboratory parameters, along with implementing a scoring system to predict outcomes, is crucial for optimizing the management of critically ill patients and enhancing their chances of survival. Methods: A prospective observational study was conducted with a cross-sectional design between November 2020 and October 2022 at a tertiary care teaching hospital in central India. Children between the age group of one month up to years getting admitted to the PICU and 12 fulfilling inclusion criteria for septic shock were enrolled in the study after taking informed written consent from parents and after getting ethical clearance from the institutional ethical committee. Detailed history of clinical presentation and associated co-morbidities of all the cases and their detailed findings on physical examination were recorded. All children were assessed using pediatric sequential organ failure assessment (pSOFA) score and presence of multiple organ dysfunction syndrome (MODS) determined at 24 hours of admission. All data were meticulously entered into a well-designed Microsoft Excel sheet. A comparison of the frequencies of variable categories across different groups was conducted utilizing the Chi-square test. Results: During the study period, 146 cases of septic shock were included in the study. The mean age was three years and eight months, and 96 (64.4%) of patients fell below five years of age. Fever was present in 119 (96.6%) cases. The most common diagnosis at the time of presentation was pneumonia in 49 (33.6%) cases, followed by meningitis in 21 (14.4%) cases and acute gastroenteritis in 18 (12.3%) cases. Hematological investigations showed leukocytosis as most common finding which was seen in all patients followed by anemia 71 (48.6%) and thrombocytopenia 46 (31.5%). Among the 27 (18.5%) culture-positive cases, Pseudomonas aeruginosa was the most common organism isolated. Out of 146 patients, 106 had MODS, of which 53 (50%) expired ( P = 0.00), which was statistically significant ( P < 0.05). On evaluating with pSOFA, the score of more than 10 was seen in 54 (96.4%) of all the nonsurvivors ( P = 0.00) which was highly statistically significant ( P < 0.05). All deaths were in ventilated patients. Conclusion: Septic shock in Indian children carries a high mortality rate. The most vulnerable group comprises children below 1 year, with pneumonia being the most common underlying cause. Risk factors for mortality include multiorgan dysfunction syndrome, a high SOFA score, and the requirement for multiple inotropes. It is vital to strictly monitor patients, assess severity using appropriate tools, and initiate immediate management according to protocol for a better outcome. Appropriate investigations and timely intervention are crucial in reducing mortality associated with septic shock.
Bokade et al. (Mon,) studied this question.