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Application of organ dysfunction assessment scores following pediatric lung transplantation
Chinyere O'Connor1,2,3, Flor M Munoz2,4,5, Maria C Gazzaneo2,3,4,6
1McGovern Medical School, UT Health Science Center at Houston, Houston, Texas, USA.
Insights
The pediatric Sequential Organ Failure Assessment (pSOFA) score is more effective than the PEdiatric Logistic Organ Dysfunction (PELOD) score in identifying lung transplant recipients at risk for prolonged morbidity. This helps guide intensive care unit (ICU) care and predict outcomes.
Area of Science:
- Pediatric critical care medicine
- Transplant surgery
- Organ dysfunction scoring systems
Background:
- Organ dysfunction (OD) is a significant complication following lung transplantation, stemming from preoperative failure, intraoperative damage, or postoperative issues.
- Assessing OD is crucial for predicting patient morbidity and guiding clinical management in the intensive care unit (ICU).
Purpose of the Study:
- To compare the effectiveness of the PEdiatric Logistic Organ Dysfunction (PELOD) score and the pediatric Sequential Organ Failure Assessment (pSOFA) score in identifying risk factors for morbidity in pediatric lung transplant recipients.
- To evaluate the utility of these scoring systems in predicting prolonged post-transplant morbidity.
Main Methods:
- A retrospective review of medical records for 98 pediatric lung transplant recipients (ages 0-20) from January 2009 to March 2016.
- PELOD and pSOFA scores were calculated on post-transplant days 1-3.
- Risk factors such as cystic fibrosis (CF), surgical time, and primary graft dysfunction (PGD) were assessed. Patients were grouped by initial scores and subsequent score trends (uptrending or downtrending).
Main Results:
- Higher pSOFA scores (≥ 5 on day 1) were associated with non-CF diagnosis and worse PGD scores (p < .001).
- Patients with uptrending pSOFA scores experienced significantly longer ventilatory and ICU days compared to those with stable or downtrending scores (p < .01).
- Similarly, uptrending PELOD scores correlated with significantly prolonged ventilatory days (p < .0001).
Conclusions:
- The pediatric Sequential Organ Failure Assessment (pSOFA) score is a more effective bedside tool than the PELOD score for identifying risk factors associated with worsened organ dysfunction post-lung transplant.
- pSOFA scores can provide valuable direction for managing morbidity outcomes in the ICU for pediatric lung transplant patients.
Objective:
Organ dysfunction (OD) after lung transplantation can reflect preoperative organ failure, intraoperative acute organ damage and post-operative complications. We assessed two OD scoring systems, both the PEdiatric Logistic Organ Dysfunction (PELOD) and the pediatric Sequential Organ Failure Assessment (pSOFA) scores, in recognizing risk factors for morbidity as well as recipients with prolonged post-transplant morbidity.
Design:
Medical records of recipients from January 2009 to March 2016 were reviewed. PELOD and pSOFA scores were calculated on post-transplant days 1-3. Risk factors assessed included cystic fibrosis (CF), prolonged surgical time and worst primary graft dysfunction (PGD) score amongst others. Patients were classified into three groups based on their initial scores (group A) and subsequent trends either uptrending (group B) or downtrending (group C). Morbidity outcomes were compared between these groups.
Results:
Total 98 patients were enrolled aged 0-20 years. Risk factors for higher pSOFA scores ≥ 5 on day 1 included non-CF diagnosis and worst PGD scores (p = .0006 and p = .03, respectively). Kruskal Wallis analysis comparing pSOFA group A versus B versus C scores showed significantly prolonged ventilatory days (median 1 vs. 4 vs. 2, p = .0028) and ICU days (median 4 vs. 10 vs. 6, p = .007). Similarly, PELOD group A versus B versus C scores showed significantly prolonged ventilatory days (1 vs. 5 vs. 2, p = < .0001).
Conclusion:
Implementing pSOFA scores bedside is a more effective tool compared to PELOD in identifying risk factors for worsened OD post-lung transplant and can be valuable in providing direction on morbidity outcomes in the ICU.
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