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Sepsis Prognostic Scores Accuracy in Predicting Adverse Outcomes in Children With Sepsis Admitted to the Pediatric
Luca Marchetto, Rosanna Comoretto, Dario Gregori1
1Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy.
Insights
Pediatric Logistic Organ Dysfunction-2 (PELOD-2) best predicts mortality and morbidity in critically ill children with sepsis. This organ dysfunction score outperformed other sepsis criteria in a 24-hour assessment for better patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Emergency Medicine
- Pediatric Sepsis Research
Background:
- Sepsis is a leading cause of mortality in critically ill children.
- Accurate early prediction of sepsis outcomes is crucial for timely intervention.
- Existing prognostic scores vary in their effectiveness for pediatric sepsis.
Purpose of the Study:
- To compare the predictive performance of multiple prognostic scores for pediatric sepsis.
- To evaluate scores calculated within the first 24 hours of admission.
- To identify the optimal score for predicting mortality and morbidity in pediatric intensive care unit (PICU) patients.
Main Methods:
- Retrospective cohort study of 60 children with sepsis admitted to the PICU.
- Calculated sepsis organ dysfunction scores (pSOFA, qSOFA, PELOD-2) and ICCPS-derived criteria on day 1.
- Compared score performance using Area Under the Receiver Operating Characteristic Curve (AUROC) for mortality and morbidity outcomes.
Main Results:
- Pediatric Logistic Organ Dysfunction-2 (PELOD-2) demonstrated the highest accuracy in predicting mortality (AUROC 0.924).
- PELOD-2 significantly outperformed SIRS criteria and severe sepsis criteria for mortality prediction.
- PELOD-2 also showed superior performance in predicting prolonged invasive mechanical ventilation and composite poor outcomes.
Conclusions:
- Early (Day 1) organ dysfunction scores are superior to ICCPS-derived criteria for predicting pediatric sepsis outcomes.
- The PELOD-2 score is the most effective prognostic tool for mortality and morbidity in critically ill children with sepsis.
- These findings support the use of PELOD-2 for early risk stratification in pediatric sepsis.
Objective:
To compare the performance of several prognostic scores calculated in the first 24 hours of admission (day 1) in predicting mortality and morbidity among critically ill children with sepsis presenting to the pediatric emergency department (PED) and then admitted to the pediatric intensive care unit (PICU).
Methods:
Single-center, retrospective cohort study in children with a diagnosis of sepsis visiting the PED and then admitted to the PICU from January 1, 2010 to December 31, 2019. Sepsis organ dysfunction scores-pediatric Sequential Organ Failure Assessment (pSOFA) (Schlapbach, Matics, Shime), quickSOFA, quickSOFA-L, Pediatric Logistic Organ Dysfunction (PELOD)-2, quickPELOD-2, and Pediatric Multiple Organ Dysfunction score-were calculated during the first 24 hours of admission (day 1) and their performance compared with systemic inflammatory response syndrome (SIRS) and severe sepsis-International Consensus Conference on Pediatric Sepsis(ICCPS)-derived criteria-using the area under the receiver operating characteristic curve. Primary outcome was PICU mortality. Secondary outcomes were: a composite of death and new disability (ie, change from baseline Pediatric Overall Performance Category score ≥1); prolonged PICU length of stay (>5 d); prolonged invasive mechanical ventilation (MV) (>3 d).
Results:
Among 60 patients with sepsis, 4 (6.7%) died, 7 (11.7%) developed new disability, 26 (43.3%) experienced prolonged length of stay, and 21 (35%) prolonged invasive MV. The prognostic ability in mortality discrimination was significantly higher for organ dysfunction scores, with PELOD-2 showing the best performance (area under the receiver operating characteristic curve, 0.924; 95% confidence interval, 0.837-1.000), significantly better than SIRS 3 criteria (0.924 vs 0.509, P = 0.009), SIRS 4 criteria (0.924 vs 0.509, P < 0.001), and severe sepsis (0.924 vs 0.527, P < 0.001). Among secondary outcomes, PELOD-2 performed significantly better than SIRS criteria and severe sepsis to predict prolonged duration of invasive MV, whereas better than severe sepsis to predict "poor outcome" (mortality or new disability).
Conclusions:
Day 1 organ dysfunction scores performed better in predicting mortality and morbidity outcomes than ICCPS-derived criteria. The PELOD-2 was the organ dysfunction score with the best performance for all outcomes.
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