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Early changes in SOFA score as a prognostic factor in pediatric oncology patients requiring mechanical ventilatory
Eun Ju Ha1, Seonguk Kim, Hyun Seung Jin
1Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Changes in outcome prediction scores within 72 hours are better predictors of mortality in pediatric oncology patients on mechanical ventilation than initial scores. Early trends in respiratory parameters also offer valuable prognostic insights.
Area of Science:
- Pediatric Intensive Care
- Oncology
- Critical Care Medicine
Background:
- Pediatric oncology patients requiring mechanical ventilation have complex prognoses.
- Accurate outcome prediction is crucial for managing these critically ill children.
Purpose of the Study:
- To compare the predictive power of serial outcome scores versus single admission scores.
- To assess the prognostic value of early changes in respiratory parameters in mechanically ventilated pediatric oncology patients.
Main Methods:
- Retrospective review of 54 pediatric oncology patients requiring mechanical ventilation >72 hours.
- Analysis of Sequential Organ Failure Assessment (SOFA) scores and respiratory parameters (P/F ratio, OI, VI) within the first 72 hours.
Main Results:
- Change in SOFA score (Δ-SOFA) showed a stronger correlation with mortality than initial SOFA score (P<0.001).
- Patients with positive Δ-SOFA had significantly lower mortality (18.5%) than those with negative Δ-SOFA (88.2%).
- Improvements in respiratory parameters (P/F ratio, OI, VI) correlated with lower mortality (P<0.01).
Conclusions:
- Serial SOFA score evaluation in the first few days predicts prognosis in ventilated pediatric oncology patients.
- Δ-SOFA within 72 hours is a strong, independent predictor of outcome.
- Early trends in respiratory parameters provide valuable prognostic information.
Purpose:
To evaluate whether changes in outcome prediction scores during the first 72 hours after admission to a pediatric intensive care unit (PICU) are more predictive of outcome than single assessments at admission in pediatric oncology patients requiring mechanical ventilatory support for more than 3 days.
Patients And Methods:
The medical records of 54 consecutive pediatric oncology patients requiring mechanical ventilation over 72 hours in the PICU of the Asan Medical Center, Seoul, Korea, between January 2006 and December 2008, were retrospectively reviewed.
Results:
Although both initial Sequential Organ Failure Assessment (SOFA) score and change in SOFA score (Δ-SOFA) correlated well with mortality, Δ-SOFA score showed a significantly stronger correlation (P<0.001) and a larger area under the receiver operating characteristic curve than did initial SOFA score. Patients with positive and negative Δ-SOFA scores showed statistically significant differences in mortality (18.5% vs. 88.2%, P<0.001). In addition, early changes in respiratory parameters, such as PaO₂/FiO₂ (P/F) ratio, oxygenation index (OI), and ventilation index (VI), evaluated serially during the first 3 days, also correlated with mortality. Patients showing improvement in these respiratory parameters displayed significantly lower mortality than did patients with worsening of these parameters (P<0.01).
Conclusions:
Serial evaluation of SOFA score during the first few days after PICU admission was a good predictor of prognosis in pediatric oncology patients mechanically ventilated over 3 days. Independent of initial SOFA score, Δ-SOFA score during the first 72 hours closely correlated with outcome. Early changes in respiratory parameters, such as P/F ratio, OI, and VI, may also provide valuable prognostic information in such patients.
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