Pediatric Sepsis Phenotype in a Single-Center Cohort Covering 2010-2020: Evolution in Day 1-Day 3 Trajectory and Potential Prognostic Value.

Abstract

Objectives: To examine the utility of day 3 sepsis phenotype classifications compared with day 1 and whether these could be reliably identified using routine clinical data on day 1.

Design: Retrospective cohort study of pediatric patients managed 2010-2014 and 2018-2020.

Setting: Academic children's hospital.

Patients: One thousand eight hundred twenty-eight children (1 mo to 18 yr old) admitted to the PICU with suspected infection who received a minimum of 7 days of systemic antibiotics.

Interventions: None.

Measurements and main results: Subjects showed significant evolution of phenotype from day 1 to day 3, with 31.7-60.9% remaining the same type. Outcomes were worst in those classifying as type D on day 3, with mortality as high as 16.6% in those that were classified as type D on both days 1 and 3, as well as 11.3% in those initially classified as type C (a lower mortality type) on day 1 but type D on day 3. Accurate statistical prediction of day 3 types using multinomial logistic regression and random forest and day 1 data was poor, despite attempts to improve performance.

Conclusions: In our retrospective cohort of patients with sepsis, we identified significant evolution in phenotype over the first 3 days of illness. Day 3 phenotypes may provide more accurate statistical prediction of outcomes, but identification of day 3 phenotypes using data available early in the course of illness is challenging. New methods will likely be required to improve performance in this area.