Abstract Ref Number = APCP260
MULTIVARIATE ANALYSIS OF CLINICAL AND NEUROENDOCRINE PROFILES ASSOCIATED TO SURVIVAL IN PEDIATRIC SEPSIS
Yuliana Yunarto,Dewi Ratih,Yusrina Istanti,M Supriatna TS,Asri Purwanti
Department of Pediatrics Faculty of Medicine Diponegoro University Dr Kariadi Hospital Department of Pediatrics, Faculty of Medicine, Diponegoro University Dr Kariadi Hospital, Semarang
Background : Sepsis is the major contributor of morbidity and mortality in children worldwide. Sepsis comprises a set of complex biological perturbations imposed by aggression on the body’s defense systems that causes modulation of the autonomic nervous system, neuroendocrine axis, metabolic and immune systems. We aimed to identify clinical and neuroendocrine variables associated to survival in pediatric sepsis.
Material : This is a cohort study conducted in Pediatric Intensive Care Unit of Dr. Kariadi Hospital from September 2012 until February 2013. A total of 30 children with a diagnosis of sepsis were enrolled consecutively. We recorded clinical characteristics including age, gender, nutritional status, cultures (collected from blood, urine, and endotracheal tube), diagnosis (surgical/nonsurgical), PIM (Pediatric Index of Mortality), PELOD (Pediatric Logistic Organ Dysfunction) score (assessed subsequently on day-1, 3, and 6), serum cortisol level and serum thyroid level taken during the first 24 hours of admission. Variables were analyzed using multiple regression analyses.
Results : Among 30 children (20 male, 10 female) with mean age of 41.7 months (2-144 months), 8 (27%) chidren did not survive, 7 (23%) children were admitted due to surgical conditions. Out of 8 nonsurvivors, 7 (88%) children had positive cultures. Pearson’s correlation test showed that cortisol level (r=0.828, P<0.001) and PELOD day-6 (r=0.774, P< 0.001) had strong correlation with survival. Multiple variable regression analysis showed a positive strong correlation between cortisol level, cultures, and PELOD day-6 with survival (r=0.884, r2=78.2%, P<0.001). Cortisol level, cultures, and PELOD day-6 had significant linear association with survival (P=0.001, P=0.026, and P=0.029, respectively). Nonsurvivors had higher PELOD day-6 (29.38 ± 16.45) and higher cortisol level (638 ± 202.06 ?g/dl) compared to survivors.
Conclusions : Cortisol level, cultures, and PELOD day-6 had significant association to pediatric sepsis survival. Nonsurvivors had higher PELOD score on day-6 and higher cortisol level in the first 24 hours of sepsis onset compared to survivors.
Keywords: pediatric sepsis neuroendocrine cortisol PELOD