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Extrarenal sequential organ failure assessment score as an outcome predictor of critically ill children on continuous

Won Kyoung Jhang1, Young A Kim, Eun Ju Ha

  • 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 138-736, Korea.

Pediatric Nephrology (Berlin, Germany)
|January 29, 2014
PubMed

Insights

A modified Sequential Organ Failure Assessment (SOFA) score, excluding the renal component, effectively predicts outcomes in critically ill children undergoing continuous renal replacement therapy (CRRT). This extrarenal SOFA score demonstrated superior predictive power compared to other established pediatric scoring systems.

Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Prognostic Biomarkers

Background:

  • The Sequential Organ Failure Assessment (SOFA) score is a validated outcome predictor in adult critical care.
  • Its application in pediatric populations is limited due to differences in baseline serum creatinine levels.
  • Pediatric intensive care units (PICUs) require reliable prognostic tools for critically ill children.

Purpose of the Study:

  • To evaluate the utility of a modified SOFA score, termed the extrarenal SOFA score, in predicting mortality in pediatric patients requiring continuous renal replacement therapy (CRRT).
  • To compare the predictive performance of the extrarenal SOFA score against established pediatric scoring systems like PRISM III and PELOD, as well as the standard SOFA score.

Main Methods:

  • A retrospective analysis of 87 pediatric patients who underwent CRRT between January 2005 and July 2011.
  • Modification of the SOFA score by excluding the renal component to create the extrarenal SOFA score.
  • Comparison of the predictive accuracy of extrarenal SOFA, SOFA, PRISM III, and PELOD scores using receiver operating characteristic (ROC) curve analysis.

Main Results:

  • The study population had a high prevalence of multiple organ dysfunction syndrome (95.4%) and a significant overall mortality rate (50.6%).
  • The extrarenal SOFA score at CRRT initiation and the presence of ≥20% fluid overload were significantly associated with mortality.
  • The extrarenal SOFA score exhibited the highest area under the ROC curve (0.774), outperforming SOFA (0.770), PRISM III (0.660), and PELOD (0.650).

Conclusions:

  • The extrarenal SOFA score demonstrates potential as a valuable prognostic marker in critically ill children receiving CRRT.
  • This modified score may offer improved outcome prediction in pediatric patients with acute kidney injury requiring renal support.
Abstract

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