LAUSR

Learning Objectives: Little is known about long-term sequelae among pediatric survivors of multiple organ dysfunction syndrome (MODS). Infants with MODS experience higher inhospital mortality than older children, and survivors may be particularly vulnerable to ongoing morbidity. We aimed to compare 5-year readmission and mortality among infants surviving acute respiratory failure (ARF) with MODS versus isolated ARF. Methods: We conducted a retrospective cohort study of all infants <1 year of age at admission surviving a first hospitalization with ARF in Washington State from 1987–2009. We used ICD-9 codes from state hospitalization records to identify ARF and additional acute organ dysfunction. We identified in-state readmissions and deaths within 5 years of discharge using state hospitalization and death certificate data. We used generalized linear Poisson regression adjusted for gestational age to estimate the risk of readmission and death for those with MODS compared to isolated ARF and for each type of organ dysfunction, and used linear regression to quantify the association of MODS and each type of organ dysfunction with the cumulative number of readmissions and readmission days. Results: Of 21,255 infants with ARF, MODS occurred in 7.0% (n=1484). The cumulative readmission rate was 45.6% of infants with MODS vs 41.1% with isolated ARF (adjusted RR 1.10, 95% CI 1.04–1.17). MODS was associated with a mean of 0.39 additional readmissions (95% CI 0.25–0.53) and 2.2 additional readmission days (0.7–3.6) relative to ARF over 5 years of follow-up. Post-discharge mortality was 8.6% in patients with MODS vs 3.9% in patients with ARF (aRR 2.22, 1.85–2.65). Each additional organ dysfunction was associated with a higher risk of readmission (aRR 1.09/organ, 1.04–1.15) and death (aRR 2.11/organ, 1.86–2.38). Post-discharge mortality among patients with ≥3 dysfunctional organs was 29.1%. Readmission and mortality were highest among patients with hepatic dysfunction, with a 68.4% readmission rate (aRR 1.74 [1.32–2.29] vs no hepatic dysfunction) and 36.8% mortality (aRR 8.25, 4.64–14.67). Conclusions: Compared to infants surviving isolated ARF, infants with additional acute organ dysfunction are at higher risk of readmission and much higher risk of death in the 5 years after discharge, suggesting the need for improved follow-up care to improve long-term outcomes in this population. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MDCCM 43