Incidence and risk factors for sepsis after childhood splenectomy
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In brief
In brief
Study of 195 pediatric splenectomy patients found 7% developed sepsis at a rate of 1.8 events per 100 person-years, with 62% occurring beyond the first postoperative year. Younger age at splenectomy was associated with increased sepsis risk, highlighting the need for long-term vigilance regarding immunologic dysfunction in asplenic children.
Written by the GCMD Library team from the article.
Background
Children who have undergone splenectomy may develop impaired immunologic function and heightened risk of overwhelming postsplenectomy infection. We sought to define the long-term rate of and risk factors for postsplenectomy sepsis.
Methods
We leveraged the Military Health System Data Repository, a nationally representative claims database including >3 million children registered as dependents of members of the United States Armed Services (2005–2014). Inclusion criterion was splenectomy at age 18 years or prior. The primary outcome was hospitalization for sepsis.
Results
Among 195 children who underwent splenectomy, 7% (n = 13) were hospitalized with sepsis, with an incidence of 1.8 (95% CI = 1.0-3.1) events per 100 person-years. The median time to sepsis was 224 days (IQR = 109–606) and 38% (5/13) of events occurred within the first postsplenectomy year. The postsplenectomy mortality rate was 1% (n = 3). After adjusting for underlying diagnosis, older age at splenectomy (HR = 0.90 per year, 95% CI = 0.81–0.99) was associated with decreased hazard of sepsis.
Conclusions
In a contemporary national cohort, the prevalence of postsplenectomy sepsis was 7% (1.8 events per 100 person-years). Although most presented during the first year after splenectomy, many (62%) sepsis events occurred later, suggesting that postsplenectomy immunologic dysfunction persists beyond one year. The immunologic consequences of asplenia must continue to be acknowledged, as postsplenectomy sepsis remains a serious concern.
Type of Study
Prognosis study.
Level of Evidence
Level III.