Project Summary Sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, encompasses a continuum that ranges from sepsis to severe sepsis, septic shock, multiple organ dysfunction syndrome (MODS) and eventually death if untreated. Sepsis is the leading cause of child mortality worldwide, with most of these deaths occurring in low and middle-income countries (LMICs). Climatic changes are closely linked to infectious diseases, which lead to sepsis in a subset of patients; for instance, rising temperatures, increased flooding, and droughts, and changing habitats may tip the ecological balance, encouraging infectious disease transmission and triggering outbreaks, such as enteric infections and diarrhea and respiratory diseases. Those living in the world’s poorest communities, particularly children and the elderly, are likely to suffer the most from escalations in climate-susceptible infectious diseases. However, despite both the greater vulnerability to climate change and the higher rates of child mortality from sepsis in these settings, there is a paucity of literature on the effects of climate change on sepsis and sepsis outcomes in LMICs. In particular, Bangladesh has been identified as one of the most vulnerable countries in the world to climate change threats. The proposed research will build additional aims related to climate change and health onto the parent R21/R33 study, “Development of a Mobile Health Personalized Physiologic Analytics Tool for Pediatric Patients with Sepsis” (R21 TW012211). We will evaluate the impact of climate trends on pediatric sepsis incidence, severity and mortality rate using data collected from the parent study of pediatric patients with sepsis admitted to the intensive care unit the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka Hospital, as well as electronic health record (EHR) data from all pediatric patients diagnosed with sepsis at the icddr,b Dhaka Hospital. Knowledge gained from this study will greatly advance the evidence base for the impact of climate and changing climate trends on critically ill children with sepsis in Bangladesh which may be applicable to other similar LMIC settings. This work also has the potential to improve the clinical prediction models for sepsis severity and risk of death that we are creating, and thereby inform clinicians of the impacts of climate on individual patient care. The proposed initiatives will also build a base of technical and professional expertise at Rhode Island Hospital and icddr,b in climate change and health research which will allow future research and collaborations to study the impacts of climate change on sepsis and infectious diseases. Increased research on the intersection of climate and sepsis, particularly in children, may allow researchers, clinicians and policy makers to best plan how to strengthen healthcare systems, better allocate scarce human and material resources, and develop interventions to support patients and communities in adapting and mitigating these public health threats.

Project Narrative The proposed research will build additional aims related to climate change and health onto the parent R21/R33 study entitled, “Development of a Mobile Health Personalized Physiologic Analytics Tool for Pediatric Patients with Sepsis” (R21 TW012211). We will evaluate the impact of climate trends on pediatric sepsis incidence, severity and mortality rate using data collected from the parent study of pediatric patients with sepsis admitted to the intensive care unit at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka Hospital, as well as electronic health record data from additional pediatric patients with sepsis.