Funding: National Institutes of Child Health and Development
Sepsis remains the second leading cause of death (after accidents and trauma) in US children. One half of these deaths occur secondary to shock in the first week, and one half after the first week from poorly understood Multiple Organ Failure (MOF) Syndrome. Mangement of shock is phenotype directed. Several phenotypes have now been recognized over the past decade in MOF as well. Thrombocytopenia associated MOF is indicative of thrombotic microangiopathy, Immunoparalysis is indicative of immune sufficiency, and Sequential MOF is indicative of viral induced lymphoproliferative disease. Each of these phenotypes can be diagnosed by typical clinical features enhanced by specific biomarker patterns. Resolution of these patterns is associated with better outcomes. Each phenotype has specific pathophysiology and specific targeted therapies. The purpose of this study is to develop a computer decision support tool which categorizes MOF according to phenotype based on accepted clinical/biomarker patterns. Using this tool we will document the incidence of these phenotypes across the network as it relates to regional and ethnic diversity. We will also use propensity analyses to determine if use of phenotype specific therapies is associated with resolution of pathologic biomarker profiles and improved outcomes. This will allow better understanding and management of MOF syndromes, just as use of phenotype directed therapies in shock has facilitated improved outcomes.