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Updated: May 2, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
The temporal version of the pediatric sepsis biomarker risk model
Hector R Wong1, Scott L Weiss2, John S Giuliano3
1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, Ohio, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America.
Insights
A new temporal PERSEVERE (tPERSEVERE) model estimates the risk of complicated courses in pediatric septic shock by tracking biomarker changes. This tool aids in monitoring patient outcomes during early interventions.
Area of Science:
- Pediatric critical care medicine
- Biomarker research
- Septic shock management
Background:
- The PERSEVERE model estimates mortality risk in pediatric septic shock using early biomarkers.
- Pediatric septic shock requires accurate risk assessment for timely intervention.
Purpose of the Study:
- To develop and validate a temporal version of the PERSEVERE model (tPERSEVERE).
- tPERSEVERE aims to predict a complicated course in pediatric septic shock using serial biomarker measurements.
Main Methods:
- Biomarkers were measured on days 1 and 3 in derivation (n=225) and test (n=74) cohorts.
- Classification and Regression Tree (CART) analysis was used to derive the tPERSEVERE model.
- The model's performance was validated and updated using combined cohort data.
Main Results:
- The tPERSEVERE model demonstrated high sensitivity (91%) and negative predictive value (96%) for complicated courses.
- The model achieved an area under the ROC curve of 0.85, indicating good discriminative ability.
- Performance was consistent across derivation, test, and combined cohorts.
Conclusions:
- tPERSEVERE effectively estimates the probability of a complicated course in pediatric septic shock.
- This temporal model can supplement physiological assessments for monitoring risk during early treatment.
Background:
PERSEVERE is a risk model for estimating mortality probability in pediatric septic shock, using five biomarkers measured within 24 hours of clinical presentation.
Objective:
Here, we derive and test a temporal version of PERSEVERE (tPERSEVERE) that considers biomarker values at the first and third day following presentation to estimate the probability of a "complicated course", defined as persistence of ≥2 organ failures at seven days after meeting criteria for septic shock, or death within 28 days.
Methods:
Biomarkers were measured in the derivation cohort (n = 225) using serum samples obtained during days 1 and 3 of septic shock. Classification and Regression Tree (CART) analysis was used to derive a model to estimate the risk of a complicated course. The derived model was validated in the test cohort (n = 74), and subsequently updated using the combined derivation and test cohorts.
Results:
A complicated course occurred in 23% of the derivation cohort subjects. The derived model had a sensitivity for a complicated course of 90% (95% CI 78-96), specificity was 70% (62-77), positive predictive value was 47% (37-58), and negative predictive value was 96% (91-99). The area under the receiver operating characteristic curve was 0.85 (0.79-0.90). Similar test characteristics were observed in the test cohort. The updated model had a sensitivity of 91% (81-96), a specificity of 70% (64-76), a positive predictive value of 47% (39-56), and a negative predictive value of 96% (92-99).
Conclusions:
tPERSEVERE reasonably estimates the probability of a complicated course in children with septic shock. tPERSEVERE could potentially serve as an adjunct to physiological assessments for monitoring how risk for poor outcomes changes during early interventions in pediatric septic shock.
