Profile of pediatric clinical sepsis with immunoparalysis in Cipto Mangunkusumo Hospital, Jakarta

BACKGROUND: Mortality in sepsis is high worldwide. Immunoparalysis is the leading cause of mortality and morbidity in severe sepsis patients. The objectives of this study were to investigate the incidence and clinical characteristics of immunoparalysis in pediatric clinical sepsis. METHODS: An observational study was conducted using primary data obtained at Cipto Mangunkusumo Hospital. The subjects were children aged 1 month-18 years with clinical sepsis. Subjects were examined and blood samples were collected for routine blood, procalcitonin, blood culture, and ex vivo Lipopolysaccharide (LPS)-induced tumor necrosis factor-alpha (TNF-alpha) examination. Immunoparalysis was defined by whole blood ex vivo TNF-alpha response to endotoxin <200 pg/mL). RESULTS: We found the incidence of immunoparalysis was 12 (17.1%) of 70 clinical sepsis subjects. Only one subjects died in immunoparalysis group. In immunoparalysis subjects, malnourished status (66.7%) was more common, and the most common focus of infection was the hematological system (41.7%), followed by nephrological and respiratory systems. CONCLUSIONS: The incidence of immunoparalysis in clinical sepsis children at RSCM was 17.1%. A large proportion of those in the immunoparalysis group had malnutrition status and hematological infection.