Multiple organ failure in children with sepsis: features of the course, diagnosis and complex treatment in the intensive care unit

Mamatkulov I.B., Ashurova G.Z., Beknazarov A.B., Talipov M.G.

Tashkent State Medical University, Tashkent, Republic of Uzbekistan

Background: Sepsis remains one of the leading causes of mortality, especially in young children. However, the determining factor of the unfavorable outcome is not the infectious process itself, but the development of multiple organ failure (MOF).
Objective: Evaluation of clinical and laboratory features of the course of sepsis with MOF in children based on the dynamics of organ dysfunction and inflammatory biomarkers.
Materials and methods: The study included 90 children aged 2 months to 6 years with a confirmed diagnosis of sepsis and signs of MOF, hospitalized in the intensive care unit in 2021–2024. Inclusion criteria: Pediatric Sequential Organ Failure Assessment (pSOFA) ≥ 3 points, procalcitonin> 0.5 ng/mL, presence of less than two organ dysfunctions. Exclusion criteria: genetic and congenital anomalies, cancer, septic shock on admission, inoperable conditions. The condition was assessed on days 1, 5, 10 and 15. PSOFA score, procalcitonin, C-reactive protein, leukocyte levels, biochemical profile (ALT, AST, bilirubin, glucose, urea, creatinine) were determined, and the duration of mechanical ventilation, ICU stay and mortality were recorded. All patients received standard multicomponent therapy in accordance with intensive care protocols for children with sepsis: respiratory support, infusion therapy, vasoactive support as indicated, correction of hemostasis disorders, and antibacterial therapy followed by de-escalation.
Results: The most common causes of sepsis were complicated pneumonia (47.8%) and purulent-destructive lung diseases (21.1%). At admission, the mean pSOFA score was 4.83 ± 0.23, consistent with a moderate degree of organ dysfunction; by day 15, the score decreased to 3.78 ± 0.55 (p=0.007). Marked positive dynamics of inflammatory biomarkers was noted: the level of leukocytes decreased from 15.4 ± 1.4 to 11.9 ± 1.0 × 109/L, C-reactive protein – from 66.0 ± 16.5 to 43.7 ± 17.1 mg/L, procalcitonin – from 7.4 ± 3.4 to 3.8 ± 1.9 ng/mL (p=0.05), which reflects the effectiveness of etiotropic antibacterial therapy with de-escalation
according to the results of cultures and, if indicated, surgical sanitation of foci of infection, against the background of concomitant respiratory, infusion and vasoactive support. Hepatic enzymes showed transient elevations on days 5–10, while renal function and diuresis remained stable within normal range throughout follow-up period. Mechanical ventilation was required by 27.8% of patients, vasoactive support – 16.7%. Mortality was 20%, mainly among children under the age of one year.
Conclusion: The dynamics of pSOFA score and inflammatory biomarkers (procalcitonin, CRP, leukocytes) in children with sepsis and MOF reflect the change in the degree of organ dysfunction and the severity of the condition during treatment. The data obtained confirm the clinical significance of these indicators for monitoring the condition and timely detection of unfavorable dynamics, which makes them informative tools for assessing the course of sepsis in the intensive care unit.

For citations: Mamatkulov I.B., Ashurova G.Z., Beknazarov A.B., Talipov M.G. Multiple organ failure in children with sepsis: features of the course, diagnosis and complex treatment in the intensive care unit. Pharmateca. 2026;33(7):65-71. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.7.65-71

Authors’ contribution: All authors made an equivalent contribution to the preparation of the publication.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Ethical Approval: The study was approved by the local bioethics committee (decision of the local ethics committee at the National Children’s Medical Center, meeting minutes No. 1/01 of 13.01.2025).
Patient Consent for Publication: Informed consent of parents/legal representatives of all included patients for publication was obtained.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.

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About the Authors

Ikhtiyor B. Mamatkulov, Cand. Sci. (Med.), Associate Professor, Department of Anesthesiology and Resuscitation, Pediatric Anesthesiology and Resuscitation, Traumatology and Orthopedics, and Neurosurgery, Tashkent State Medical University, Tashkent, Uzbekistan; mikhtiyor77@mail.ru, ORCID: https://orcid.org/0000-0003-4053-4544 (corresponding author)
Gulchekhra Z. Ashurova, Cand. Sci. (Med.), Associate Professor, Department of Anesthesiology and Resuscitation, Pediatric Anesthesiology and Resuscitation, Traumatology and Orthopedics, and Neurosurgery, Tashkent State Medical University, Tashkent, Uzbekistan; ORCID:
https://orcid.org/0000-0001-6437-8967
Amir B. Beknazarov, Assistant Professor, Department of Anesthesiology and Resuscitation, Pediatric Anesthesiology and Resuscitation, Traumatology and Orthopedics, and Neurosurgery, Tashkent State Medical University, Tashkent, Uzbekistan; ORCID: https://orcid.org/0000-0002-6260-5190
Mamur G. Talipov, Assistant Professor, Department of Anesthesiology and Resuscitation, Pediatric Anesthesiology and Resuscitation, Traumatology and Orthopedics, and Neurosurgery, Tashkent State Medical University, Tashkent, Uzbekistan; ORCID: https://orcid.org/0000-0001-8281-0442

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