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Accuracy of SIRS, age-adapted pSOFA, and quick SOFA scoring systems for predicting outcomes in paediatric patients
Jingmin Sun1, Jing Li2, De Wu2
1Department of Nephrology, Children's Hospital of Anhui Medical University, Hefei, China; Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hafei, China.
Insights
The Sequential Organ Failure Assessment (SOFA) score is more effective than the Systemic Inflammatory Response Syndrome (SIRS) criteria for predicting sepsis mortality in pediatric intensive care units (PICUs). Further research is recommended.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Biostatistics
Background:
- Sepsis is a primary cause of mortality in pediatric populations.
- Existing scoring systems for predicting sepsis outcomes in children lack comparative data on sensitivity and specificity.
Purpose of the Study:
- To systematically compare the accuracy of the SOFA score and SIRS criteria in predicting mortality in pediatric sepsis patients.
- To evaluate the diagnostic performance of these scoring systems using a meta-analysis approach.
Main Methods:
- A systematic literature review adhering to PRISMA guidelines was conducted.
- Databases searched included PubMed, CENTRAL, and Google Scholar for studies from January 1990 to March 2021.
- A random-effects model was employed to calculate pooled sensitivity, specificity, and summary receiver operating characteristic (SROC) curves, with heterogeneity assessed using I² statistics.
Main Results:
- Eleven studies evaluated the SOFA score, yielding a pooled sensitivity of 83% (95% CI: 76%-88%), specificity of 72% (95% CI: 60%-81%), and SROC of 85% (95% CI: 82%-88%) for mortality prediction.
- Six studies examined the SIRS system, with pooled sensitivity at 80% (95% CI: 64%-90%), specificity at 36% (95% CI: 23%-51%), and SROC at 59% (95% CI: 55%-63%).
- The SOFA score demonstrated superior performance in predicting mortality compared to the SIRS system.
Conclusions:
- The SOFA score is a more effective tool than SIRS for predicting mortality in pediatric intensive care unit (PICU) patients with sepsis.
- Further prospective, multi-centric studies are warranted to validate these findings and refine predictive accuracy.
Background:
Sepsis is the leading cause of mortality in children. Several scoring systems are used to predict outcome and mortality for pediatric patients with sepsis, but how they compare to each other in terms of sensitivity and specificity is unclear.
Methods:
The systematic literature review was performed following PRISMA guidelines. Publically accessible search engines and study databases such as PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar were scanned for articles published from January 1990 to March 2021 using relevant key words. All relevant studies were analyzed separately by two reviewers. A random-effects model was used to calculate the pooled sensitivity and pooled specificity with a 95% confidence interval (CI). Heterogeneity was evaluated using I2, which estimates the percentage of variation between study results due to heterogeneity rather than sampling error.
Results:
Eleven studies met inclusion criteria and evaluated the SOFA scoring system. The pooled sensitivity, specificity, and SROC for prediction of mortality were 83% (95% CI: 76%-88%), 72% (95% CI: 60%-81%), and 85% (95% CI: 82%-88%), respectively. Six studies examined the SIRS system. Pooled sensitivity, specificity, and SROC were 80% (95% CI: 64%-90%), 36% (95% CI: 23%-51%), and 59% (95% CI: 55%-63%), respectively.
Conclusion:
This meta-analysis shows that SOFA was superior to SIRS for predicting mortality in PICU patients with sepsis. Additional prospective multi-centric studies are needed to better evaluate and validate this finding.
