Mortality rate and predictors of mortality of pediatric sepsis and septic shock in a Moroccan tertiary care center.

BACKGROUND

Sepsis is the leading cause of child mortality worldwide. Pediatric sepsis-related mortality in Africa is estimated to be as high as 40%. We aimed to assess sepsis-related mortality and to identify predictors of mortality in pediatric sepsis.

METHODS

We conducted a retrospective observational study of children admitted to the PICU for sepsis or septic shock. Statistical analysis was performed using Jamovi version 2.3.28. Continuous variables are expressed as mean ± standard deviation (SD) and categorical variables as frequencies and percentages. The Mann-Whitney U test assessed the association between the pediatric sequential sepsis-related organ failure assessment "pSOFA" score and mortality. Logistic regression was used to identify mortality predictors. Model performance was assessed based on discrimination and calibration. Statistical significance was set at p < 0.05.

RESULTS

We enrolled 130 patients. The mean age was 32.5 months (SD: 47.12, range: 1-180). The identified infection sites were pneumonia (53.1%), central nervous system (23.8%), gastrointestinal tract (15.4%), bloodstream (4.5%), bone and joint (2.3%), and urinary tract (0.8%). Biological assessment showed the following mean values: 14,076 E/mm3 for leukocytes (SD: 9,162, range: 350-59,100), 349 x 103 E/mm3 for platelets (SD: 214, range: 10-939) and 111 mg/L for C-reactive protein "CRP" (SD 122, range:1-480). The median pSOFA score was six (range: 2-18). A microorganism was isolated in 32.3% of cases, including SARS-CoV-2 (5.2%), Streptococcus pneumoniae (3.7%), respiratory syncytial virus (3%), and Pseudomonas aeruginosa (2.3%). The overall mortality rate was 50%. Statistical analysis showed an association between the pSOFA score and mortality (p < 0.001). Lower platelet count, vasopressor use, and mechanical ventilation were independently associated with mortality. The logistic regression model performed well with a p-value < 0.001 and a McFadden R2 of 0.415. The area under the ROC curve was 0.888. The sensitivity, specificity, and accuracy were 88.9%, 85.1%, and 87.0%, respectively, with acceptable calibration.

CONCLUSION

Our research assessed pediatric sepsis in Morocco, a lower-middle-income North African country. Mortality rates were higher compared to high-income countries. The pSOFA score was effective in predicting severity and mortality. Lower platelet count, vasopressor use, and mechanical ventilation were identified as independent predictors of mortality.