SEPSIS-3 propuso una nueva definición para identificar adultos con sepsis en Urgencias. En niños, los datos son escasos.

Objetivo: Describir cuántos niños con shock séptico (ShS) cumplieron el criterio de ShS de SEPSIS-3 al ingreso a Urgencias y comparar evolución clínica y mortalidad.

Métodos: Análisis secundario de estudio multicéntrico prospectivo (10/2019-06/2021). Incluimos niños de 30 días a 18 años. Participaron 10 centros latinoamericanos. Recolectamos variables epidemiológicas y clínicas. Definimos ShS según SEPSIS-3 como sepsis más uso de vasopresores para mantener la presión arterial media ≥ 65 mmHg y lactato > 2 mmol/L. Para evaluar riesgo de muerte, realizamos un modelo de regression logística multivariado. Informamos OR e IC95, consideramos significativa p< 0,05.

Resultados: De 219 niños, incluimos 150. Cumplieron el criterio de ShS de SEPSIS-3 43 (29%). Mediana de edad 3,8 años (RIC 1,2-11). No encontramos diferencias epidemiológicas entre grupos. Observamos diferencias en los marcadores clínicos de gravedad, niveles de lactato y PCR. El grupo ShS SEPSIS-3 demandó mayor necesidad de intubación en Urgencias (44% vs. 13%, p< 0,01), requerimiento de asistencia ventilatoria mecánica en Cuidados Intensivos (UTIP) (61% vs. 22%, p< 0,01) e ingreso a UTIP (93% vs. 45%, p< 0,01). También observamos scores de Evaluación Secuencial del Daño Multiorgánico pediátrico (mediana de 8 [RIC 4-11] vs. 3 [RIC 1-5], p< 0,01) y mortalidad (36% vs. 4%, p< 0,01) mayores en ShS SEPSIS-3, con OR de morir de 17 (IC95 5-63).

Conclusión: Los niños ingresados en Urgencias con ShS que cumplieron con los criterios de ShS SEPSIS-3 presentaron mayor morbimortalidad. La baja proporción de pacientes que tuvieron un qSOFA positivo muestra su escasa utilidad para la detección temprana de la sepsis.

In adults, SEPSIS-3 proposed a new definition to identify sepsis in emergency departments. However, data are lacking regarding its application in children.

Objective: To determine the proportion of children presenting with septic shock (SSh) that met the SEPSIS-3 SSh criteria upon admission to the emergency department, and to compare the clinical course and mortality rates between the two groups.

Methods: We conducted a secondary analysis of data from a prospective multicenter study conducted between October 2019 and June 2021. We included children aged 30 days to 18 years from 10 Latin American centers. Demographic and clinical variables were collected. SSh was defined according to the SEPSIS-3 criteria as sepsis plus the use of vasopressors to maintain a mean arterial pressure of ≥ 65 mmHg and a serum lactate level > 2 mmol/L. To assess the mortality risk, a multivariate logistic regression model was used. The findings are reported as odds ratios (OR) with the corresponding 95% confidence intervals (CIs).

Results: Out of 219 children, 150 were included, 43 (29%) of whom met the SEPSIS-3 SSh criteria. The median age was 3.8 years (IQR, 1.2-11). No significant demographic differences were observed between the groups. However, we did identify significant differences in clinical markers of severity, including serum lactate levels and C-reactive protein (CRP). In the SEPSIS-3 SSh group, more patients required intubation in the emergency department (44% vs. 13%, p< 0.01), mechanical ventilation support in the pediatric intensive care unit (PICU) (61% vs. 22%, p< 0.01), and admission to the PICU (93% vs. 45%, p< 0.01). In addition, in the SEPSIS-3 SSh group we observed higher Sequential Organ Failure Assessment (SOFA) scores (median 8 [IQR 4-11] vs. 3 [IQR 1-5], p< 0.01), as well as increased mortality (36% vs. 4%, p< 0.01), with an OR for death of 17 (95% CI 5-63).

Conclusion: Children admitted to the emergency department with SSh who met the SEPSIS-3 criteria had higher rates of morbidity and mortality. The low proportion of patients with a positive quick SOFA score indicates its limited validity for early detection of sepsis.