Resumen: La sepsis es una causa importante de morbilidad y mortalidad pediátrica, especialmente en países de bajos recursos. Los datos sobre la prevalencia regional, las tendencias de mortalidad y su relación con variables socioeconómicas son escasos. Objetivo: determinar la prevalencia regional, mortalidad y situación sociodemográfica en pacientes con diagnóstico de sepsis severa (SS) y shock séptico (ShS) ingresados a Unidades de Cuidado Intensivo Pediátrico (UCIPs). Pacientes y Método: Se incluyeron pacientes de 1 a 216 meses de edad ingresados en 47 UCIPs participantes con diagnóstico de SS o ShS entre el 1 de enero de 2010 y el 31 de diciembre de 2018. Se efectuó análisis secundario de la base de datos del Programa de Benchmarking de Calidad de la Sociedad Argentina de Terapia Intensiva (SATI-Q) para SS y ShS, y revisión de los informes anuales del Ministerio de Salud de Argentina y del Instituto Nacional de Estadística y Censos para los índices sociodemográficos de los años correspondientes. Resultados: Se registraron 45.480 ingresos en 47 UCIPs, 3.777 con diagnóstico de SS y ShS. La prevalencia combinada de SS y ShS disminuyó del 9,9% en 2010 al 6,6% en 2018. La mortalidad combinada disminuyó del 34,5% al 23,5%. El análisis multivariado mostró que el Odds ratio (OR) de la asociación entre la mortalidad del SS y el ShS fue de 1,88 (IC 95%: 1,46-2,32) y 2,4 (IC 95%: 2,162,66) respectivamente, ajustada por enfermedad maligna, PIM2 y ventilación mecánica. La prevalencia de SS y ShS en diferentes regiones sanitarias (RS) se asoció con el porcentaje de pobreza y la tasa de mortalidad infantil (p < 0,001). Sin embargo, no hubo asociación entre la mortalidad por sepsis y la RS ajustada por PIM2. Conclusiones: La prevalencia y la mortalidad por SS y ShS han disminuido con el tiempo en las UCIP participantes. Las condiciones socioeconómicas más bajas se asociaron con una mayor prevalencia pero con resultados similares de la sepsis.

Abstract: Sepsis is an important cause of pediatric morbidity and mortality, especially in low-income countries. Data on regional prevalence, mortality trends, and their relationship with socioeconomic variables are scarce. Objective: to determine the regional prevalence, mortality, and sociodemographic situation of patients diagnosed with severe sepsis (SS) and septic shock (SSh) admitted to Pediatric Intensive Care Units (PICUs). Patients and Method: patients aged 1 to 216 months admitted to 47 participating PICUs with a diagnosis of SS or SSh between January 1, 2010, and December 31, 2018, were included. Secondary analysis was performed on the Argentine Society of Intensive Care Benchmarking Quality Program (SATI-Q) database for SS and SSh and a review of the annual reports of the Argentine Ministry of Health and the National Institute of Statistics and Census for the sociodemographic indices of the respective years. Results: 45,480 admissions were recorded in 47 PICUs, 3,777 of them with a diagnosis of SS and SSh. The combined prevalence of SS and SSh decreased from 9.9% in 2010 to 6.6% in 2018. The combined mortality decreased from 34.5% to 23.5%. Multivariate analysis showed that the Odds ratio (OR) of the association between SS and SSh mortality was 1.88 (95% CI: 1.46-2.32) and 2.4 (95% CI: 2.16-2.66), respectively, adjusted for malignant disease, PIM2, and mechanical ventilation. The prevalence of SS and SSh in different health regions (HR) was associated with the percentage of poverty and infant mortality rate (p < 0.001). However, there was no association between sepsis mortality and HR adjusted for PIM2. Conclusions: Prevalence and mortality of SS and SSh have decreased over time in the participating PICUs. Lower socioeconomic conditions were associated with higher prevalence but similar sepsis outcomes.

Resumen: La sepsis es una causa importante de morbilidad y mortalidad pediátrica, especialmente en países de bajos recursos. Los datos sobre la prevalencia regional, las tendencias de mortalidad y su relación con variables socioeconómicas son escasos. Objetivo: determinar la prevalencia regional, mortalidad y situación sociodemográfica en pacientes con diagnóstico de sepsis severa (SS) y shock séptico (ShS) ingresados a Unidades de Cuidado Intensivo Pediátrico (UCIPs). Pacientes y Método: Se incluyeron pacientes de 1 a 216 meses de edad ingresados en 47 UCIPs participantes con diagnóstico de SS o ShS entre el 1 de enero de 2010 y el 31 de diciembre de 2018. Se efectuó análisis secundario de la base de datos del Programa de Benchmarking de Calidad de la Sociedad Argentina de Terapia Intensiva (SATI-Q) para SS y ShS, y revisión de los informes anuales del Ministerio de Salud de Argentina y del Instituto Nacional de Estadística y Censos para los índices sociodemográficos de los años correspondientes. Resultados: Se registraron 45.480 ingresos en 47 UCIPs, 3.777 con diagnóstico de SS y ShS. La prevalencia combinada de SS y ShS disminuyó del 9,9% en 2010 al 6,6% en 2018. La mortalidad combinada disminuyó del 34,5% al 23,5%. El análisis multivariado mostró que el Odds ratio (OR) de la asociación entre la mortalidad del SS y el ShS fue de 1,88 (IC 95%: 1,46-2,32) y 2,4 (IC 95%: 2,162,66) respectivamente, ajustada por enfermedad maligna, PIM2 y ventilación mecánica. La prevalencia de SS y ShS en diferentes regiones sanitarias (RS) se asoció con el porcentaje de pobreza y la tasa de mortalidad infantil (p < 0,001). Sin embargo, no hubo asociación entre la mortalidad por sepsis y la RS ajustada por PIM2. Conclusiones: La prevalencia y la mortalidad por SS y ShS han disminuido con el tiempo en las UCIP participantes. Las condiciones socioeconómicas más bajas se asociaron con una mayor prevalencia pero con resultados similares de la sepsis.

Abstract: Sepsis is an important cause of pediatric morbidity and mortality, especially in low-income countries. Data on regional prevalence, mortality trends, and their relationship with socioeconomic variables are scarce. Objective: to determine the regional prevalence, mortality, and sociodemographic situation of patients diagnosed with severe sepsis (SS) and septic shock (SSh) admitted to Pediatric Intensive Care Units (PICUs). Patients and Method: patients aged 1 to 216 months admitted to 47 participating PICUs with a diagnosis of SS or SSh between January 1, 2010, and December 31, 2018, were included. Secondary analysis was performed on the Argentine Society of Intensive Care Benchmarking Quality Program (SATI-Q) database for SS and SSh and a review of the annual reports of the Argentine Ministry of Health and the National Institute of Statistics and Census for the sociodemographic indices of the respective years. Results: 45,480 admissions were recorded in 47 PICUs, 3,777 of them with a diagnosis of SS and SSh. The combined prevalence of SS and SSh decreased from 9.9% in 2010 to 6.6% in 2018. The combined mortality decreased from 34.5% to 23.5%. Multivariate analysis showed that the Odds ratio (OR) of the association between SS and SSh mortality was 1.88 (95% CI: 1.46-2.32) and 2.4 (95% CI: 2.16-2.66), respectively, adjusted for malignant disease, PIM2, and mechanical ventilation. The prevalence of SS and SSh in different health regions (HR) was associated with the percentage of poverty and infant mortality rate (p < 0.001). However, there was no association between sepsis mortality and HR adjusted for PIM2. Conclusions: Prevalence and mortality of SS and SSh have decreased over time in the participating PICUs. Lower socioeconomic conditions were associated with higher prevalence but similar sepsis outcomes.

OBJETIVOS: Descrever a epidemiologia, as características clínicas e o tratamento do dengue e das síndromes do choque associadas ao dengue. FONTES DOS DADOS: Para esta revisão de literatura, foi feita uma pesquisa no Pubmed e nos websites da Organização Mundial da Saúde (OMS) e OPAS usando os termos dengue e síndrome do choque associada ao dengue. A informação foi complementada com a experiência pessoal dos autores. SÍNTESE DOS DADOS: O dengue é a mais importante doença viral transmitida por artrópodos em seres humanos. A doença se manifesta de diversas formas, variando desde uma síndrome viral não-diferenciada até febre hemorrágica e choque grave. O dengue é uma enfermidade autolimitada, não específica, caracterizada por febre, cefaléia, mialgia, e sintomas constitucionais. As formas mais graves (febre hemorrágica e síndrome do choque) podem levar a um comprometimento multissistêmico e ao óbito. O diagnóstico precoce e um acompanhamento contínuo do agravamento e da resposta ao tratamento são necessários em todos os casos. A OMS recomenda uma abordagem escalonada para o manejo, adequada para as formas mais leves e para o choque precoce. Nas formas mais graves, é preciso uma abordagem agressiva de reanimação com fluidos e de suporte à falência de órgãos em pacientes em estado crítico. As pesquisas sobre as diferenças fisiopatológicas entre o choque do dengue e o choque séptico, seleção de fluidos, agentes inotrópicos e técnicas de suporte a órgãos podem beneficiar os pacientes em estado crítico. CONCLUSÕES: Não há uma terapia específica para infecções causadas pelo dengue. Um bom tratamento de suporte pode salvar vidas mas, em última análise, as iniciativas de controle do vetor e de prevenção contra picadas do mosquito podem trazer os maiores benefícios.

OBJECTIVES: To describe the epidemiology, clinical features and treatment of dengue fever and dengue shock syndrome. SOURCES: To prepare this review, a literature search was made on Pubmed and on the World Health Organization (WHO) and PAHO websites using the terms dengue and dengue shock syndrome. This information was complemented with personal practice. SUMMARY OF THE FINDINGS: Dengue is the most important arthropod-borne viral disease of humans. Its presentation is protean and varies from an undifferentiated viral syndrome to hemorrhagic fever and severe shock. Dengue fever is a self-limiting, nonspecific illness characterized by fever, headache, myalgia, and constitutional symptoms. Its severe forms (hemorrhagic fever and shock syndrome) may lead to multisystem involvement and death. Early diagnosis, close monitoring for deterioration and response to treatment are necessary in all cases. WHO has provided a stepwise approach to management that is useful for milder forms and early shock. In the more severe forms aggressive fluid resuscitation and support for failing organs is necessary for the critically ill patient. Research addressing pathophysiological differences between dengue shock and septic shock, choice of fluids, inotropes and techniques of organ support are likely to yield benefits for the critically ill. CONCLUSIONS: There is no specific therapy for dengue infections. Good supportive care may be lifesaving, but ultimately initiatives aimed at vector control and prevention of mosquito bites may provide the greatest benefits.