Abstract Ref Number = APCP974
ANALYSIS OF CLINICAL FACTORS AND NEUROENDOCRINE CHANGES AFFECTING OUTCOME IN PEDIATRIC SEPSIS
Suciati Jandraningrum,Dewi Ratih,Yusrina Istanti,M Supriatna TS,Asri Purwanti
Department of Pediatrics Faculty of Medicine Diponegoro University Dr Kariadi Hospital Semarang Department of Pediatrics, Faculty of Medicine, Diponegoro University Dr Kariadi Hospital, Semarang
Background : Sepsis is a life-threatening condition that drives physiological changes interaction between immune, autonomic, and neuroendocrine systems in response to infection. The two main neuroendocrine changes during sepsis are hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axis malfunction. This study used factor analysis on constructing factors including neuroendocrine profile affecting outcome in pediatric sepsis.
Material : This is a cohort study of 30 consecutively enrolled children with sepsis admitted to Pediatric Intensive Care Unit in Dr. Kariadi Hospital in 2012. A total of 13 clinical characteristics of the patient were recorded including age, gender, nutritional status, blood culture, diagnosis (surgical/nonsurgical), serum cortisol level, serum thyroid profile (T3, T4, and TSH), PIM (Pediatric Index of Mortality), and PELOD (Pediatric Logistic Organ Dysfunction) score (assessed subsequently on day-1, 3, and 6). Variables were analyzed using factor analysis followed by linear regression model.
Results : Out of 30 children, 8 (27%) children did not survive. Factor analysis was used to construct factors affecting outcome in pediatric sepsis. Three factors were extracted with an eigenvalue of > 1. Factor 1 comprised of PIM (0.600), Cortisol level (0.857), PELOD day-3 (0.913), and PELOD day-6 (0.927) with variance of 46.69%; Factor 2 comprised of Diagnosis (0.841) with variance of 19.06%; and Factor 3 comprised of TSH level (0.844) with variance of 14.60%. Cumulative % of Factor 1 and Factor 2 was 65.76%. Together, all three factors account for 80.36% of the variability in the 13 clinical variables. Linear regression analysis demonstrated strong correlation between the three factors and the outcome (r = 0.801), and significantly explained 64.2% of the variance on outcome (P <0.001).
Conclusions : Three factors were constructed using factor analysis and assigned as the factors affecting outcome in pediatric sepsis. Factor 1 comprised of PIM, Cortisol level, PELOD day-3, and PELOD day-6; Factor 2 comprised of Diagnosis; and Factor 3 comprised of TSH level. Comprehensive management regarding to these three factors may improve outcome in pediatric sepsis.
Keywords: pediatric sepsis neuroendocrine analysis factor