Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU

Area of Science:

• Pediatric critical care medicine
• Sepsis research
• Clinical scoring systems

Background:

• Sepsis is a leading cause of mortality in children admitted to pediatric intensive care units (PICUs).
• Accurate prognostic scoring systems are crucial for timely intervention and resource allocation in pediatric sepsis management.
• The Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score is a validated tool for assessing sepsis severity in critically ill children.

Purpose of the Study:

• To evaluate the predictive validity of the day-1 PELOD-2 and day-1 "quick" PELOD-2 (qPELOD-2) scores for in-hospital mortality in pediatric sepsis patients.
• To compare the predictive performance of PELOD-2 and qPELOD-2 with other scoring systems like pediatric SOFA (pSOFA) and Pediatric Multiple Organ Dysfunction Score (P-MODS).
• To assess the utility of these scores in a developing country context.

Main Methods:

• Retrospective analysis of 516 children diagnosed with sepsis in a PICU.
• Categorization of patients into survival and non-survival groups based on 28-day outcomes.
• Collection and scoring of day-1 PELOD-2, day-1 qPELOD-2, pSOFA, and P-MODS.
• Receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC) for each scoring system's predictive accuracy.

Main Results:

• Non-survivors exhibited significantly higher day-1 PELOD-2, day-1 qPELOD-2, pSOFA, and P-MODS scores compared to survivors.
• ROC analysis revealed high predictive accuracy for all scores: PELOD-2 (AUC=0.916), qPELOD-2 (AUC=0.802), pSOFA (AUC=0.937), and P-MODS (AUC=0.761).
• The pSOFA score demonstrated the highest AUC, closely followed by the day-1 PELOD-2 score, indicating strong predictive capabilities for both.

Conclusions:

• Both day-1 PELOD-2 and day-1 qPELOD-2 scores are effective in assessing prognosis for pediatric sepsis patients in a developing country PICU.
• The day-1 PELOD-2 score demonstrated superior predictive performance compared to the day-1 qPELOD-2 score.
• Further research is recommended to validate the utility of the day-1 qPELOD-2 score, especially in settings outside the PICU.