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

Sharon Y. Irving, Bridget Daly, Judy Verger, Katri V. Typpo, Ann Marie Brown, Alexandra Hanlon, Scott L. Weiss, Julie C. Fitzgerald, Vinay M. Nadkarni, Neal J. Thomas, Vijay Srinivasan, P. Fontela, M. Tucci, M. Dumis-trascu, P. Skippen, G. Krahn, E. Bezares, G. Puig, A. Puig-Ramos, R. GarciaM. Villar, M. Bigham, T. Polanski, S. Latifi, D. Giebner, H. Anthony, J. Hume, A. Galster, L. Linnerud, R. Sanders, G. Hefley, K. Madden, A. Thompson, S. Shein, S. Gertz, Y. Han, T. Williams, A. Hughes-Schalk, H. Chandler, A. Orioles, E. Zielinski, A. Doucette, C. Zebuhr, T. Wilson, C. Dimitriades, J. Ascani, S. Layburn, S. Valley, B. Markowitz, J. Terry, R. Morzov, A. Mcinnes, J. McArthur, K. Woods, K. Murkowski, M. Spaeder, M. Sharron, D. Wheeler, E. Beckman, E. Frank, K. Howard, C. Carroll, S. Nett, D. Jarvis, V. Patel, R. Higgerson, L. Christie, K. Typpo, J. Deschenes, Aileen Kirby, T. Uhl, K. Rehder, I. Cheifetz, S. Wrenn, K. Kypuros, K. Ackerman, F. Maffei, G. Bloomquist, N. Rizkalla, D. Kimura, S. Shah, C. Tigges, F. Su, C. Barlow, K. Michelson, K. Wolfe, D. Goodman, L. Campbell, L. Sorce, K. Bysani, T. Monjure, M. Evans, B. Totapally, M. Chegondi, C. Rodriguez, J. Frazier, L. Steele, S. Viteri, A. Costarino

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e1029-e1039
JournalCritical care medicine
Volume46
Issue number11
DOIs
StatePublished - Jan 1 2018

Fingerprint

Nutritional Status
Sepsis
Body Mass Index
Outcome Assessment (Health Care)
Overnutrition
Malnutrition
Length of Stay
Therapeutics
Survivors
Pediatrics
Child Mortality
Mortality
South America
North America
South Africa
New Zealand
Odds Ratio

Keywords

  • Children
  • Nutrition status
  • Nutrition support
  • Outcomes
  • Septic shock
  • Severe sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

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. / Irving, Sharon Y.; Daly, Bridget; Verger, Judy; Typpo, Katri V.; Brown, Ann Marie; Hanlon, Alexandra; Weiss, Scott L.; Fitzgerald, Julie C.; Nadkarni, Vinay M.; Thomas, Neal J.; Srinivasan, Vijay; Fontela, P.; Tucci, M.; Dumis-trascu, M.; Skippen, P.; Krahn, G.; Bezares, E.; Puig, G.; Puig-Ramos, A.; Garcia, R.; Villar, M.; Bigham, M.; Polanski, T.; Latifi, S.; Giebner, D.; Anthony, H.; Hume, J.; Galster, A.; Linnerud, L.; Sanders, R.; Hefley, G.; Madden, K.; Thompson, A.; Shein, S.; Gertz, S.; Han, Y.; Williams, T.; Hughes-Schalk, A.; Chandler, H.; Orioles, A.; Zielinski, E.; Doucette, A.; Zebuhr, C.; Wilson, T.; Dimitriades, C.; Ascani, J.; Layburn, S.; Valley, S.; Markowitz, B.; Terry, J.; Morzov, R.; Mcinnes, A.; McArthur, J.; Woods, K.; Murkowski, K.; Spaeder, M.; Sharron, M.; Wheeler, D.; Beckman, E.; Frank, E.; Howard, K.; Carroll, C.; Nett, S.; Jarvis, D.; Patel, V.; Higgerson, R.; Christie, L.; Typpo, K.; Deschenes, J.; Kirby, Aileen; Uhl, T.; Rehder, K.; Cheifetz, I.; Wrenn, S.; Kypuros, K.; Ackerman, K.; Maffei, F.; Bloomquist, G.; Rizkalla, N.; Kimura, D.; Shah, S.; Tigges, C.; Su, F.; Barlow, C.; Michelson, K.; Wolfe, K.; Goodman, D.; Campbell, L.; Sorce, L.; Bysani, K.; Monjure, T.; Evans, M.; Totapally, B.; Chegondi, M.; Rodriguez, C.; Frazier, J.; Steele, L.; Viteri, S.; Costarino, A.

In: Critical care medicine, Vol. 46, No. 11, 01.01.2018, p. e1029-e1039.

Research output: Contribution to journalArticle

Irving, SY, Daly, B, Verger, J, Typpo, KV, Brown, AM, Hanlon, A, Weiss, SL, Fitzgerald, JC, Nadkarni, VM, Thomas, NJ, Srinivasan, V, Fontela, P, Tucci, M, Dumis-trascu, M, Skippen, P, Krahn, G, Bezares, E, Puig, G, Puig-Ramos, A, Garcia, R, Villar, M, Bigham, M, Polanski, T, Latifi, S, Giebner, D, Anthony, H, Hume, J, Galster, A, Linnerud, L, Sanders, R, Hefley, G, Madden, K, Thompson, A, Shein, S, Gertz, S, Han, Y, Williams, T, Hughes-Schalk, A, Chandler, H, Orioles, A, Zielinski, E, Doucette, A, Zebuhr, C, Wilson, T, Dimitriades, C, Ascani, J, Layburn, S, Valley, S, Markowitz, B, Terry, J, Morzov, R, Mcinnes, A, McArthur, J, Woods, K, Murkowski, K, Spaeder, M, Sharron, M, Wheeler, D, Beckman, E, Frank, E, Howard, K, Carroll, C, Nett, S, Jarvis, D, Patel, V, Higgerson, R, Christie, L, Typpo, K, Deschenes, J, Kirby, A, Uhl, T, Rehder, K, Cheifetz, I, Wrenn, S, Kypuros, K, Ackerman, K, Maffei, F, Bloomquist, G, Rizkalla, N, Kimura, D, Shah, S, Tigges, C, Su, F, Barlow, C, Michelson, K, Wolfe, K, Goodman, D, Campbell, L, Sorce, L, Bysani, K, Monjure, T, Evans, M, Totapally, B, Chegondi, M, Rodriguez, C, Frazier, J, Steele, L, Viteri, S & Costarino, A 2018, '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', Critical care medicine, vol. 46, no. 11, pp. e1029-e1039. https://doi.org/10.1097/CCM.0000000000003351
Irving, Sharon Y. ; Daly, Bridget ; Verger, Judy ; Typpo, Katri V. ; Brown, Ann Marie ; Hanlon, Alexandra ; Weiss, Scott L. ; Fitzgerald, Julie C. ; Nadkarni, Vinay M. ; Thomas, Neal J. ; Srinivasan, Vijay ; Fontela, P. ; Tucci, M. ; Dumis-trascu, M. ; Skippen, P. ; Krahn, G. ; Bezares, E. ; Puig, G. ; Puig-Ramos, A. ; Garcia, R. ; Villar, M. ; Bigham, M. ; Polanski, T. ; Latifi, S. ; Giebner, D. ; Anthony, H. ; Hume, J. ; Galster, A. ; Linnerud, L. ; Sanders, R. ; Hefley, G. ; Madden, K. ; Thompson, A. ; Shein, S. ; Gertz, S. ; Han, Y. ; Williams, T. ; Hughes-Schalk, A. ; Chandler, H. ; Orioles, A. ; Zielinski, E. ; Doucette, A. ; Zebuhr, C. ; Wilson, T. ; Dimitriades, C. ; Ascani, J. ; Layburn, S. ; Valley, S. ; Markowitz, B. ; Terry, J. ; Morzov, R. ; Mcinnes, A. ; McArthur, J. ; Woods, K. ; Murkowski, K. ; Spaeder, M. ; Sharron, M. ; Wheeler, D. ; Beckman, E. ; Frank, E. ; Howard, K. ; Carroll, C. ; Nett, S. ; Jarvis, D. ; Patel, V. ; Higgerson, R. ; Christie, L. ; Typpo, K. ; Deschenes, J. ; Kirby, Aileen ; Uhl, T. ; Rehder, K. ; Cheifetz, I. ; Wrenn, S. ; Kypuros, K. ; Ackerman, K. ; Maffei, F. ; Bloomquist, G. ; Rizkalla, N. ; Kimura, D. ; Shah, S. ; Tigges, C. ; Su, F. ; Barlow, C. ; Michelson, K. ; Wolfe, K. ; Goodman, D. ; Campbell, L. ; Sorce, L. ; Bysani, K. ; Monjure, T. ; Evans, M. ; Totapally, B. ; Chegondi, M. ; Rodriguez, C. ; Frazier, J. ; Steele, L. ; Viteri, S. ; Costarino, A. / 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. In: Critical care medicine. 2018 ; Vol. 46, No. 11. pp. e1029-e1039.
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abstract = "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.",
keywords = "Children, Nutrition status, Nutrition support, Outcomes, Septic shock, Severe sepsis",
author = "Irving, {Sharon Y.} and Bridget Daly and Judy Verger and Typpo, {Katri V.} and Brown, {Ann Marie} and Alexandra Hanlon and Weiss, {Scott L.} and Fitzgerald, {Julie C.} and Nadkarni, {Vinay M.} and Thomas, {Neal J.} and Vijay Srinivasan and P. Fontela and M. Tucci and M. Dumis-trascu and P. Skippen and G. Krahn and E. Bezares and G. Puig and A. Puig-Ramos and R. Garcia and M. Villar and M. Bigham and T. Polanski and S. Latifi and D. Giebner and H. Anthony and J. Hume and A. Galster and L. Linnerud and R. Sanders and G. Hefley and K. Madden and A. Thompson and S. Shein and S. Gertz and Y. Han and T. Williams and A. Hughes-Schalk and H. Chandler and A. Orioles and E. Zielinski and A. Doucette and C. Zebuhr and T. Wilson and C. Dimitriades and J. Ascani and S. Layburn and S. Valley and B. Markowitz and J. Terry and R. Morzov and A. Mcinnes and J. McArthur and K. Woods and K. Murkowski and M. Spaeder and M. Sharron and D. Wheeler and E. Beckman and E. Frank and K. Howard and C. Carroll and S. Nett and D. Jarvis and V. Patel and R. Higgerson and L. Christie and K. Typpo and J. Deschenes and Aileen Kirby and T. Uhl and K. Rehder and I. Cheifetz and S. Wrenn and K. Kypuros and K. Ackerman and F. Maffei and G. Bloomquist and N. Rizkalla and D. Kimura and S. Shah and C. Tigges and F. Su and C. Barlow and K. Michelson and K. Wolfe and D. Goodman and L. Campbell and L. Sorce and K. Bysani and T. Monjure and M. Evans and B. Totapally and M. Chegondi and C. Rodriguez and J. Frazier and L. Steele and S. Viteri and A. Costarino",
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TY - JOUR

T1 - The association of nutrition status expressed as body mass index z score with outcomes in children with severe sepsis

T2 - A secondary analysis from the sepsis prevalence, outcomes, and therapies (SPROUT) study

AU - Irving, Sharon Y.

AU - Daly, Bridget

AU - Verger, Judy

AU - Typpo, Katri V.

AU - Brown, Ann Marie

AU - Hanlon, Alexandra

AU - Weiss, Scott L.

AU - Fitzgerald, Julie C.

AU - Nadkarni, Vinay M.

AU - Thomas, Neal J.

AU - Srinivasan, Vijay

AU - Fontela, P.

AU - Tucci, M.

AU - Dumis-trascu, M.

AU - Skippen, P.

AU - Krahn, G.

AU - Bezares, E.

AU - Puig, G.

AU - Puig-Ramos, A.

AU - Garcia, R.

AU - Villar, M.

AU - Bigham, M.

AU - Polanski, T.

AU - Latifi, S.

AU - Giebner, D.

AU - Anthony, H.

AU - Hume, J.

AU - Galster, A.

AU - Linnerud, L.

AU - Sanders, R.

AU - Hefley, G.

AU - Madden, K.

AU - Thompson, A.

AU - Shein, S.

AU - Gertz, S.

AU - Han, Y.

AU - Williams, T.

AU - Hughes-Schalk, A.

AU - Chandler, H.

AU - Orioles, A.

AU - Zielinski, E.

AU - Doucette, A.

AU - Zebuhr, C.

AU - Wilson, T.

AU - Dimitriades, C.

AU - Ascani, J.

AU - Layburn, S.

AU - Valley, S.

AU - Markowitz, B.

AU - Terry, J.

AU - Morzov, R.

AU - Mcinnes, A.

AU - McArthur, J.

AU - Woods, K.

AU - Murkowski, K.

AU - Spaeder, M.

AU - Sharron, M.

AU - Wheeler, D.

AU - Beckman, E.

AU - Frank, E.

AU - Howard, K.

AU - Carroll, C.

AU - Nett, S.

AU - Jarvis, D.

AU - Patel, V.

AU - Higgerson, R.

AU - Christie, L.

AU - Typpo, K.

AU - Deschenes, J.

AU - Kirby, Aileen

AU - Uhl, T.

AU - Rehder, K.

AU - Cheifetz, I.

AU - Wrenn, S.

AU - Kypuros, K.

AU - Ackerman, K.

AU - Maffei, F.

AU - Bloomquist, G.

AU - Rizkalla, N.

AU - Kimura, D.

AU - Shah, S.

AU - Tigges, C.

AU - Su, F.

AU - Barlow, C.

AU - Michelson, K.

AU - Wolfe, K.

AU - Goodman, D.

AU - Campbell, L.

AU - Sorce, L.

AU - Bysani, K.

AU - Monjure, T.

AU - Evans, M.

AU - Totapally, B.

AU - Chegondi, M.

AU - Rodriguez, C.

AU - Frazier, J.

AU - Steele, L.

AU - Viteri, S.

AU - Costarino, A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Children

KW - Nutrition status

KW - Nutrition support

KW - Outcomes

KW - Septic shock

KW - Severe sepsis

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UR - http://www.scopus.com/inward/citedby.url?scp=85054898156&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000003351

DO - 10.1097/CCM.0000000000003351

M3 - Article

C2 - 30095495

AN - SCOPUS:85054898156

VL - 46

SP - e1029-e1039

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 11

ER -