Open AccessImmunomodulator use in paediatric severe sepsis and septic shock
Author(s) -
Ashley Hsi Yin Chua,
Rajia Sultana,
Jan Hau Lee,
Johnson Wong
Publication year - 2021
Publication title -
annals, academy of medicine, singapore/annals of the academy of medicine, singapore
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.299
H-Index - 60
ISSN - 0304-4602
DOI - 10.47102/annals-acadmedsg.2021178
Subject(s) - medicine , septic shock , sepsis , odds ratio , pediatric intensive care unit , univariate analysis , intensive care unit , mechanical ventilation , confidence interval , retrospective cohort study , organ dysfunction , intensive care medicine , multivariate analysis
: The use of drugs that modulate the immune system during paediatric severe sepsis andseptic shock may alter the course of disease and is poorly studied. This study aims to characterise thesechildren who received immunomodulators and describe their clinical outcomes.Methods: This is a retrospective chart review of patients with severe sepsis and septic shock admitted intothe paediatric intensive care unit (PICU). Clinical, haematological and outcome characteristics of patientswith or without exposure to immune-modulating drugs were compared. Primary outcome was PICUmortality; secondary outcomes were 28-day ventilator-free days (VFD) and intensive care unit-free days(IFD). Univariate and multivariable analyses were performed for these outcomes.Results: A total of 109 patients with paediatric severe sepsis or septic shock were identified. Of thisnumber, 47 (43.1%), 16 (14.7%) and 3 (2.8%) patients received systemic corticosteroids, intravenousimmunoglobulins and granulocyte colony stimulating factor, respectively. Patients who receivedimmune-modulating drugs were more likely to require invasive ventilation (38/54 [70.4%] versus 26/55[47.3%], P=0.019) compared to those who did not. PICU mortality was indifferent between the 2 groups(20/54 [37.0%] vs 11/55 [20.0%], P=0.058) even after accounting for chronic complex conditions andadmission organ dysfunction (PELOD score) (adjusted odds ratio 1.90, confidence interval [0.72–5.01],P=0.193). However, VFD (19.5 [0–28] vs 25 [12–28] days, P=0.038) and IFD (15 [0–24] vs 22 [9–26]days, P=0.024) were decreased in the immunomodulator group compared to the non-immunomodulatorgroup.Conclusion: Immune-modulating drugs were frequently used in paediatric severe sepsis and septicshock. Patients who received these drugs seemed to require more PICU support. Further studies arerequired to examine this association thoroughly.Keywords: Children, immunomodulatory drugs, infection, paediatric intensive care unit, sepsis