Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: A Retrospective Study.

Objectives To evaluate the proportion of children fulfilling definition and Pediatric Sepsis Consensus definition among children diagnosed to have septic shock and compare the mortality risk between the two groups. Design Retrospective chart review. Setting PICU of a tertiary care teaching hospital from 2014 to 2017. Patients Children (≤ 17 yr old) with a diagnosis of septic shock at admission or during PICU stay. Interventions None. Measurements and main results We applied both Pediatric Sepsis Consensus and the new definition (sepsis with hypotension requiring vasopressors and a lactate value of ≥ 2 mmol/L) to identify cases of septic shock by these definitions. Key outcomes such as mortality, proportion attaining shock reversal at 24 hours and organ dysfunction were compared between those fulfilling group) and those fulfilling International Pediatric Sepsis Consensus Conference definition (International Pediatric Sepsis Consensus Conference group). A total of 216 patients fulfilled Pediatric Sepsis Consensus of septic shock. Of these, 104 (48%; 95% CI, 42-55) fulfilled definition. Children fulfilling Sepsis-3 plus Pediatric Sepsis Consensus definitions (Sepsis-3 and Pediatric Sepsis Consensus Conference group) had lower proportion with shock resolution (61% vs 82%; relative risk, 0.73; 95% CI, 0.62-0.88) and higher risk of multiple organ dysfunction (85% vs 68%; 1.24; 1.07-1.45) at 24 hours. The mortality was 48.5% in Sepsis-3 and Pediatric Sepsis Consensus Conference group as compared with 37.5% in the International Pediatric Sepsis Consensus only group (relative risk, 1.3; 95% CI, 0.94-1.75). Conclusions Less than half of children with septic shock identified by Pediatric Sepsis Consensus were observed to fulfill the criteria for shock as per definitions. Lack of difference in the risk of mortality between children who fulfilled definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of septic shock in children.