Half of Pediatric Sepsis Deaths Have Persistent Inflammation

According to a study published in the journal Chest, over half of pediatric sepsis deaths at Vanderbilt University Medical Center over the last 20 years displayed indications of an inflammatory state known as PICS (persistent inflammation, immunosuppression, and catabolism syndrome). PICS children were more likely to have had cardiac surgery and had a greater rate of fungal infections.

“These associations have never been explicitly linked before, especially in the context of children, and can inform further research into these uniquely vulnerable populations,” said Ryan Stark, MD, assistant professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt and senior author of the study.

Sepsis is an excessive response to infection with a 25% fatality rate. Although early detection and advances in critical care therapy have reduced overall pediatric sepsis deaths, some patients who survive the initial shock acquire PICS and remain prone to sepsis-related disease and death.

“PICS has been associated with increased late mortality, but most of the literature is from adult populations,” said Stephanie Patterson, MD, MS, assistant professor of Pediatrics and first author of the study. “The impact of PICS in critically ill children, particularly those with sepsis, remains mostly undescribed.”

The researchers examined all pediatric patients (age 21 or under) who died of sepsis from a known source from 1997 to 2020 using VUMC’s de-identified database of electronic health information. They analyzed related infections and comorbidities as well as laboratory data to assess the presence of pediatric PICS (pPICS).

The researchers discovered that 262 (47%) of 557 patients who died from sepsis had signs of pPICS. Patients with pPICS were more likely than those without to have underlying hematologic, oncologic, or cardiac illness, as well as an associated fungal infection. Patients with pPICS were also more common in the cardiac critical care unit than in the pediatric intensive care unit.

According to the researchers, the link of fungal infection with pPICS shows that patients with this syndrome may benefit from prophylactic antifungals.

Because the study only looked at individuals who died, no inferences can be drawn about the prevalence of pPICS in patients who survived sepsis or in patients who did not have sepsis.

“Further studies are needed to assess overall prevalence and risks for pPICS, as well as potentially modifiable factors that could improve outcomes for this group of patients,” Stark said. Clinicians should be aware of the potential for pPICS in children who have had surgery for congenital heart disease or other heart-related conditions, or who have underlying hematologic or oncologic disease.

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