Emergence of a Technology-Dependent Phenotype of Pediatric Sepsis in a Large Children’s Hospital

To investigate whether pediatric sepsis phenotypes are stable in time.Retrospective cohort study examining children with suspected sepsis admitted to a PICU at a large free-standing children's hospital during two distinct periods: 2010-2014 (Early Cohort) and 2018-2020 (Late Cohort). K-means consensus clustering was used to derive types separately in the cohorts. Variables included ensured representation of all organ systems.1,091 subjects were in the Early Cohort and 737 subjects in the Late Cohort. Clustering analysis yielded 4 phenotypes in the Early Cohort and 5 in the Late Cohort. Four types were in both: Type A (34% of Early Cohort, 25% of Late Cohort), mild sepsis, with minimal organ dysfunction and low mortality; Type B (25%, 22%), primary respiratory failure; Type C (25%, 18%), liver dysfunction, coagulopathy, and higher measures of systemic inflammation; Type D (16%, 17%), severe multiorgan dysfunction, with high degrees of cardiorespiratory support, renal dysfunction, and highest mortality. Type E was only detected in the Late Cohort (19%) and was notable for respiratory failure less severe than B or D, mild hypothermia, and high proportion of diagnoses and technologic dependence associated with medical complexity. Despite low mortality, this type had the longest PICU length of stay.This single center study identified 4 pediatric sepsis phenotypes in an earlier epoch but 5 in a later epoch, with the new type having a large proportion of characteristics associated with medical complexity, particularly technology dependence. Personalized sepsis therapies need to account for this expanding patient population.