Estimating Mortality Rates in Neonates with Septic Shock: What Value has Early Hemodynamic Parameters?

Background: With regards to shock cases, children admitted to intensive care units often present septic shock as the most common type of shock. It has been identified as the leading cause of morbidity and mortality among the neonatal population, especially in sub-Saharan Africa (SSA).

Objective: In this study, we aim at determining the value, if any, of hemodynamic parameters in estimating the outcome in early septic shock incidence among the neonatal population.

Methods: Eighty-two neonates with septic shock were divided into “survivors” and “non- survivors” according to their survival status within 4 weeks (28-days). The differences in stroke volume (SV), cardiac output (CO), cardiac index (CI) and systemic vascular resistance index (SVRI) were compared between survivors and non-survivors. Receiver operating characteristic (ROC) curves for 28-day mortality were constructed to compare the area under the curve (AUC) among SV, CO and CI. The test characteristics of the different cut-off values, including sensitivity, specificity, area under the ROC curve (AUC), positive likelihood and negative likelihood ratio were equally examined.

Results: Of 82 cases of neonates with septic shock in this study, 52 were survivors and 30 non-survivors. The hemodynamic parameters of SV, CO and CI were higher in survivors than in non-survivors (all p < 0.05). The AUC values of SV, CO and CI to predict 28-day mortality were 0.724, 0.742, and 0.729, respectively. SV had sensitivity, specificity, PPV, and NPV of 75.0%, 75.0%, 40.9% and 92.9, respectively.CO had sensitivity, specificity, PPV, and NPV of 91.7%, 55.7%, 67.6% and 96.7%, respectively.CI had sensitivity, specificity, PPV, and NPV of 91.7%, 67.3%, 60.7% and 97.2%, respectively.CO achieved the highest AUC, sensitivity and PPV in predicting mortality. Conclusion: SV, CO and CI may be valuable in estimating the 28- day mortality of neonates in the early stage of septic shock.

Keywords: Neonates; septic shock; hemodynamics; value; ROC curve.