The Association of Nutrition Status Expressed as Body Mass Index z Score With Outcomes in Children With Severe Sepsis: A Secondary Analysis From the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study

Objectives: The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis. Design: Secondary analysis of the Sepsis Prevalence, Outcomes, and Therapies study. Patient characteristics, ICU interventions, and outcomes were compared across nutrition status categories (expressed as age- and sex-adjusted body mass index z scores using World Health Organization standards). Multivariable regression models were developed to determine adjusted differences in all-cause ICU mortality and ICU length of stay by nutrition status. Setting: One-hundred twenty-eight PICUs across 26 countries. Patients: Children less than 18 years with severe sepsis enrolled in the Sepsis Prevalence, Outcomes, and Therapies study (n = 567). Interventions: None. Measurements and Main Results: Nutrition status data were available for 417 patients. Severe undernutrition was seen in Europe (25%), Asia (20%), South Africa (17%), and South America (10%), with severe overnutrition seen in Australia/New Zealand (17%) and North America (14%). Severe undernutrition was independently associated with all-cause ICU mortality (adjusted odds ratio, 3.0; 95% CI, 1.2–7.7; p = 0.02), whereas severe overnutrition in survivors was independently associated with longer ICU length of stay (1.6 d; p = 0.01). Conclusions: There is considerable variation in nutrition status for children with severe sepsis treated across this selected network of PICUs from different geographic regions. Severe undernutrition was independently associated with higher all-cause ICU mortality in children with severe sepsis. Severe overnutrition was independently associated with greater ICU length of stay in childhood survivors of severe sepsis. Members of the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators are listed in Appendix 1. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/29S62lw). Supported, in part, by the Endowed Chair, Department of Anesthesia and Critical Care, University of Pennsylvania Perelman School of Medicine, and the Center for Pediatric Clinical Effectiveness at the Children's Hospital of Philadelphia. Dr. Weiss is also supported by National Institute of General Medical Sciences K23GM110496. Financial support for data collection in all U.K. centers was provided by the U.K. National Institute of Health (NIHR) Clinical Research Network and in Southampton by the Southampton NIHR Wellcome Trust Clinical Research Facility. None of the funders participated in the design and conduct of study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the article. Dr. Daly received funding from the Biostatistics Consulting Unit at the University of Pennsylvania School of Nursing. Dr. Typpo's institution received funding from the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases, and Baxter. Dr. Brown received funding from Akron Children's Hospital Foundation for a different research project, but none related to this project. Dr. Hanlon's institution received funding from the Children's Hospital of Philadelphia (CHOP). Dr. Weiss's institution received funding from Center for Pediatric Clinical Effectiveness at CHOP and National Institute of General Medical Sciences K23GM110496; he received funding from ThemoFisher Scientific (honoraria for lectures unrelated to current topic), Medscape via an unrestricted grant from Roche, and Bristol-Myers Squibb Company (Member of Advisory Panel); and he received support for article research from the NIH. Dr. Fitzgerald's institution received funding from CHOP Center for Pediatric Clinical Effectiveness. Dr. Thomas received funding from Therabron, CareFusion, and Gene Fluidics. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: srinivasan@email.chop.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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