Research

Improved survival of children with sepsis and purpura: effects of age, gender, and era

Martine Maat¹ , Corinne MP Buysse² , Marieke Emonts¹ , Lodewijk Spanjaard³ , Koen FM Joosten² , Ronald de Groot⁴ and Jan A Hazelzet²

¹Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands

²Department of Paediatrics, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Center, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands

³Netherlands Reference Laboratory for Bacterial Meningitis, Department of Medical Microbiology, Academic Medical Center Amsterdam, Meibergdreef 15, 1100 DD Amsterdam, The Netherlands

⁴Department of Paediatrics, University Medical Center St. Radboud, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands

author email corresponding author email

Critical Care 2007, 11:R112doi:10.1186/cc6161

Published:	18 October 2007

See related commentary by Paize and Playfor, http://ccforum.com/content/11/5/172

Abstract

Background

To gain insight into factors that might affect results of future case-control studies, we performed an analysis of children with sepsis and purpura admitted to the paediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital (Rotterdam, The Netherlands).

Methods

Between 1988 and 2006, all 287 children consecutively admitted with sepsis and purpura were included in various sepsis studies. Data regarding age, gender, ethnicity, serogroup of Neisseria meningitidis, severity, therapy, and survival were collected prospectively. These data were pooled into one database and analyzed retrospectively.

Results

The case fatality rate (CFR) from sepsis and purpura was 15.7%. During the study period, survival improved significantly. Younger age was significantly associated with more severe disease and a higher CFR. Children under the median age of 3.0 years had an increased risk of case fatality (odds ratio 4.3, 95% confidence interval 2.1 to 9.2; p < 0.001). Gender was not associated with CFR. However, males did have higher Paediatric Risk of Mortality scores, fewer PICU-free days, and more presence of shock. The course of sepsis and purpura was not related to ethnic origin. A causative organism was isolated in 84.3% of cases. N. meningitidis was the major organism (97.5%). Although N. meningitidis serogroup B was observed more often in younger children, serogroups were not associated with severity or survival. During the study period, the use of inotropic agents and corticosteroids changed substantially (less dopamine and more dobutamine, norepinephrine, and corticosteroids).

Conclusion

Age and gender are determinants of severity of paediatric sepsis and purpura. Survival rates have improved during the last two decades.