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Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study
Background Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS‐ped) and to verify its association...
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| Published in: | Journal of human nutrition and dietetics 2021-04, Vol.34 (2), p.365-373 |
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| container_title | Journal of human nutrition and dietetics |
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| creator | Hauschild, D. B. Oliveira, L. D. A. Ventura, J. C. Farias, M. S. Barbosa, E. Bresolin, N. L. Moreno, Y. M. F. |
| description | Background
Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS‐ped) and to verify its association with clinical outcomes.
Methods
A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS‐ped, based on adult definition, was described. PICS‐ped was defined as PICU length of stay >14 days; C‐reactive protein > 10.0 mg L−1; lymphocytes |
| doi_str_mv | 10.1111/jhn.12798 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2431826705</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2431826705</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3538-9e0219f39ba3370619f3e1b167ae508bae7171383d97636e45ed3a6d7b59af933</originalsourceid><addsrcrecordid>eNp1kcFu1DAQhi0EokvhwAsgS1xaibR2vIkTbmgFtKiCSoDELXKcWXZWjp16HKo8Ey-JyxYOSMzFI-ubTzP6GXsuxZnMdb7f-TNZ6rZ5wFZS1VVRav3tIVuJtioL1Wh5xJ4Q7YUQtRTiMTtSpa71WqgV-3kNkZAS-MTRb50ZR5Mw-Fccx3H2geZpikCUv7jxA7cmmT44pJHT4ocYRuAn15ebz6d5nNuICa1xbuHoHLc7dEMEz5G4IQoWTYKB32LacevQ36E8zMlmC73mhk8x0AQ24Q_gLvjvmOYBfYYoN8tT9mhrHMGz-_eYfX339svmorj69P5y8-aqsKpSTdGCKGW7VW1vlNL55NyD7GWtDVSi6Q1oqaVq1NDqWtWwrmBQph50X7Vm2yp1zE4O3rzOzQyUuhHJgnPGQ5ipK9dKNmWtRZXRl_-g-zDHvHGmKtGWuql0manTA2XzfRRh200RRxOXToruLsEuJ9j9TjCzL-6Ncz_C8Jf8E1kGzg_ALTpY_m_qPlx8PCh_ARwVqJw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2509278572</pqid></control><display><type>article</type><title>Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Hauschild, D. B. ; Oliveira, L. D. A. ; Ventura, J. C. ; Farias, M. S. ; Barbosa, E. ; Bresolin, N. L. ; Moreno, Y. M. F.</creator><creatorcontrib>Hauschild, D. B. ; Oliveira, L. D. A. ; Ventura, J. C. ; Farias, M. S. ; Barbosa, E. ; Bresolin, N. L. ; Moreno, Y. M. F.</creatorcontrib><description>Background
Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS‐ped) and to verify its association with clinical outcomes.
Methods
A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS‐ped, based on adult definition, was described. PICS‐ped was defined as PICU length of stay >14 days; C‐reactive protein > 10.0 mg L−1; lymphocytes <25%; and any reduction of mid‐upper arm circumference Z‐score. Clinical, demographic, nutritional status, nutrition therapy parameters and clinical outcomes were assessed. Statistical analysis comprised Mann–Whitney and Fisher’s chi‐squared tests, as well as logistic and Cox regression. P < 0.05 was considered statistically significant.
Results
In total, 153 children were included, with a median age of 51.7 months (interquartile range 15.6–123.4 months), and 60.8% male. The mortality rate was 10.5%. The prevalence of PICS‐ped was 4.6%. Days using vasoactive drugs and days using antibiotics were associated with PICS‐ped. PICS‐ped was associated with mortality in crude (odds ratio = 6.67; P = 0.013) and adjusted analysis (odds ratio = 7.14; P = 0.017). PICS‐ped was also associated with PICU and hospital length of stay, as well as duration of mechanical ventilation. Similar results were found in a subset of critically ill children who required mechanical ventilation for more than 48 h.
Conclusions
Children with PICS‐ped required antibiotics or vasoactive drugs for a longer period. PICS‐ped was associated with poor clinical outcomes in critically ill children. More studies are needed to properly define PICS‐ped for this population.
In an exploratory study of PICU patients, PICS‐ped exists in critically ill children. The PICS‐ped for critically ill children defined in our study was associated with duration of MV, hospital LOS and mortality, even in a subset of critically ill children mechanical ventilated for more than 48 h.</description><identifier>ISSN: 0952-3871</identifier><identifier>EISSN: 1365-277X</identifier><identifier>DOI: 10.1111/jhn.12798</identifier><identifier>PMID: 32767403</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Antibiotics ; Arm circumference ; Catabolism ; Children ; Clinical outcomes ; Correlation analysis ; Immunosuppression ; Immunosuppressive agents ; Inflammation ; Length of stay ; Longitudinal studies ; Lymphocytes ; Mechanical ventilation ; Mortality ; muscle protein ; Nutrition ; Nutrition therapy ; Nutritional status ; paediatric intensive care units ; Regression analysis ; Statistical analysis ; Vasoactive agents ; Ventilation ; Ventilators</subject><ispartof>Journal of human nutrition and dietetics, 2021-04, Vol.34 (2), p.365-373</ispartof><rights>2020 The British Dietetic Association Ltd.</rights><rights>2021 The British Dietetic Association Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-9e0219f39ba3370619f3e1b167ae508bae7171383d97636e45ed3a6d7b59af933</citedby><cites>FETCH-LOGICAL-c3538-9e0219f39ba3370619f3e1b167ae508bae7171383d97636e45ed3a6d7b59af933</cites><orcidid>0000-0002-4983-2911 ; 0000-0002-0492-0352 ; 0000-0003-0147-4243 ; 0000-0002-3897-4244</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32767403$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hauschild, D. B.</creatorcontrib><creatorcontrib>Oliveira, L. D. A.</creatorcontrib><creatorcontrib>Ventura, J. C.</creatorcontrib><creatorcontrib>Farias, M. S.</creatorcontrib><creatorcontrib>Barbosa, E.</creatorcontrib><creatorcontrib>Bresolin, N. L.</creatorcontrib><creatorcontrib>Moreno, Y. M. F.</creatorcontrib><title>Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study</title><title>Journal of human nutrition and dietetics</title><addtitle>J Hum Nutr Diet</addtitle><description>Background
Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS‐ped) and to verify its association with clinical outcomes.
Methods
A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS‐ped, based on adult definition, was described. PICS‐ped was defined as PICU length of stay >14 days; C‐reactive protein > 10.0 mg L−1; lymphocytes <25%; and any reduction of mid‐upper arm circumference Z‐score. Clinical, demographic, nutritional status, nutrition therapy parameters and clinical outcomes were assessed. Statistical analysis comprised Mann–Whitney and Fisher’s chi‐squared tests, as well as logistic and Cox regression. P < 0.05 was considered statistically significant.
Results
In total, 153 children were included, with a median age of 51.7 months (interquartile range 15.6–123.4 months), and 60.8% male. The mortality rate was 10.5%. The prevalence of PICS‐ped was 4.6%. Days using vasoactive drugs and days using antibiotics were associated with PICS‐ped. PICS‐ped was associated with mortality in crude (odds ratio = 6.67; P = 0.013) and adjusted analysis (odds ratio = 7.14; P = 0.017). PICS‐ped was also associated with PICU and hospital length of stay, as well as duration of mechanical ventilation. Similar results were found in a subset of critically ill children who required mechanical ventilation for more than 48 h.
Conclusions
Children with PICS‐ped required antibiotics or vasoactive drugs for a longer period. PICS‐ped was associated with poor clinical outcomes in critically ill children. More studies are needed to properly define PICS‐ped for this population.
In an exploratory study of PICU patients, PICS‐ped exists in critically ill children. The PICS‐ped for critically ill children defined in our study was associated with duration of MV, hospital LOS and mortality, even in a subset of critically ill children mechanical ventilated for more than 48 h.</description><subject>Antibiotics</subject><subject>Arm circumference</subject><subject>Catabolism</subject><subject>Children</subject><subject>Clinical outcomes</subject><subject>Correlation analysis</subject><subject>Immunosuppression</subject><subject>Immunosuppressive agents</subject><subject>Inflammation</subject><subject>Length of stay</subject><subject>Longitudinal studies</subject><subject>Lymphocytes</subject><subject>Mechanical ventilation</subject><subject>Mortality</subject><subject>muscle protein</subject><subject>Nutrition</subject><subject>Nutrition therapy</subject><subject>Nutritional status</subject><subject>paediatric intensive care units</subject><subject>Regression analysis</subject><subject>Statistical analysis</subject><subject>Vasoactive agents</subject><subject>Ventilation</subject><subject>Ventilators</subject><issn>0952-3871</issn><issn>1365-277X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kcFu1DAQhi0EokvhwAsgS1xaibR2vIkTbmgFtKiCSoDELXKcWXZWjp16HKo8Ey-JyxYOSMzFI-ubTzP6GXsuxZnMdb7f-TNZ6rZ5wFZS1VVRav3tIVuJtioL1Wh5xJ4Q7YUQtRTiMTtSpa71WqgV-3kNkZAS-MTRb50ZR5Mw-Fccx3H2geZpikCUv7jxA7cmmT44pJHT4ocYRuAn15ebz6d5nNuICa1xbuHoHLc7dEMEz5G4IQoWTYKB32LacevQ36E8zMlmC73mhk8x0AQ24Q_gLvjvmOYBfYYoN8tT9mhrHMGz-_eYfX339svmorj69P5y8-aqsKpSTdGCKGW7VW1vlNL55NyD7GWtDVSi6Q1oqaVq1NDqWtWwrmBQph50X7Vm2yp1zE4O3rzOzQyUuhHJgnPGQ5ipK9dKNmWtRZXRl_-g-zDHvHGmKtGWuql0manTA2XzfRRh200RRxOXToruLsEuJ9j9TjCzL-6Ncz_C8Jf8E1kGzg_ALTpY_m_qPlx8PCh_ARwVqJw</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Hauschild, D. B.</creator><creator>Oliveira, L. D. A.</creator><creator>Ventura, J. C.</creator><creator>Farias, M. S.</creator><creator>Barbosa, E.</creator><creator>Bresolin, N. L.</creator><creator>Moreno, Y. M. F.</creator><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4983-2911</orcidid><orcidid>https://orcid.org/0000-0002-0492-0352</orcidid><orcidid>https://orcid.org/0000-0003-0147-4243</orcidid><orcidid>https://orcid.org/0000-0002-3897-4244</orcidid></search><sort><creationdate>202104</creationdate><title>Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study</title><author>Hauschild, D. B. ; Oliveira, L. D. A. ; Ventura, J. C. ; Farias, M. S. ; Barbosa, E. ; Bresolin, N. L. ; Moreno, Y. M. F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-9e0219f39ba3370619f3e1b167ae508bae7171383d97636e45ed3a6d7b59af933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Antibiotics</topic><topic>Arm circumference</topic><topic>Catabolism</topic><topic>Children</topic><topic>Clinical outcomes</topic><topic>Correlation analysis</topic><topic>Immunosuppression</topic><topic>Immunosuppressive agents</topic><topic>Inflammation</topic><topic>Length of stay</topic><topic>Longitudinal studies</topic><topic>Lymphocytes</topic><topic>Mechanical ventilation</topic><topic>Mortality</topic><topic>muscle protein</topic><topic>Nutrition</topic><topic>Nutrition therapy</topic><topic>Nutritional status</topic><topic>paediatric intensive care units</topic><topic>Regression analysis</topic><topic>Statistical analysis</topic><topic>Vasoactive agents</topic><topic>Ventilation</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hauschild, D. B.</creatorcontrib><creatorcontrib>Oliveira, L. D. A.</creatorcontrib><creatorcontrib>Ventura, J. C.</creatorcontrib><creatorcontrib>Farias, M. S.</creatorcontrib><creatorcontrib>Barbosa, E.</creatorcontrib><creatorcontrib>Bresolin, N. L.</creatorcontrib><creatorcontrib>Moreno, Y. M. F.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of human nutrition and dietetics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hauschild, D. B.</au><au>Oliveira, L. D. A.</au><au>Ventura, J. C.</au><au>Farias, M. S.</au><au>Barbosa, E.</au><au>Bresolin, N. L.</au><au>Moreno, Y. M. F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study</atitle><jtitle>Journal of human nutrition and dietetics</jtitle><addtitle>J Hum Nutr Diet</addtitle><date>2021-04</date><risdate>2021</risdate><volume>34</volume><issue>2</issue><spage>365</spage><epage>373</epage><pages>365-373</pages><issn>0952-3871</issn><eissn>1365-277X</eissn><abstract>Background
Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS‐ped) and to verify its association with clinical outcomes.
Methods
A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS‐ped, based on adult definition, was described. PICS‐ped was defined as PICU length of stay >14 days; C‐reactive protein > 10.0 mg L−1; lymphocytes <25%; and any reduction of mid‐upper arm circumference Z‐score. Clinical, demographic, nutritional status, nutrition therapy parameters and clinical outcomes were assessed. Statistical analysis comprised Mann–Whitney and Fisher’s chi‐squared tests, as well as logistic and Cox regression. P < 0.05 was considered statistically significant.
Results
In total, 153 children were included, with a median age of 51.7 months (interquartile range 15.6–123.4 months), and 60.8% male. The mortality rate was 10.5%. The prevalence of PICS‐ped was 4.6%. Days using vasoactive drugs and days using antibiotics were associated with PICS‐ped. PICS‐ped was associated with mortality in crude (odds ratio = 6.67; P = 0.013) and adjusted analysis (odds ratio = 7.14; P = 0.017). PICS‐ped was also associated with PICU and hospital length of stay, as well as duration of mechanical ventilation. Similar results were found in a subset of critically ill children who required mechanical ventilation for more than 48 h.
Conclusions
Children with PICS‐ped required antibiotics or vasoactive drugs for a longer period. PICS‐ped was associated with poor clinical outcomes in critically ill children. More studies are needed to properly define PICS‐ped for this population.
In an exploratory study of PICU patients, PICS‐ped exists in critically ill children. The PICS‐ped for critically ill children defined in our study was associated with duration of MV, hospital LOS and mortality, even in a subset of critically ill children mechanical ventilated for more than 48 h.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>32767403</pmid><doi>10.1111/jhn.12798</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4983-2911</orcidid><orcidid>https://orcid.org/0000-0002-0492-0352</orcidid><orcidid>https://orcid.org/0000-0003-0147-4243</orcidid><orcidid>https://orcid.org/0000-0002-3897-4244</orcidid></addata></record> |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Antibiotics Arm circumference Catabolism Children Clinical outcomes Correlation analysis Immunosuppression Immunosuppressive agents Inflammation Length of stay Longitudinal studies Lymphocytes Mechanical ventilation Mortality muscle protein Nutrition Nutrition therapy Nutritional status paediatric intensive care units Regression analysis Statistical analysis Vasoactive agents Ventilation Ventilators |
| title | Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study |
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