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A Controlled Mouse Model for Neonatal Polymicrobial Sepsis
Published on: January 27, 2019
A Need for a Novel Survival Risk Scoring System for Intensive Care Admissions Due to Sepsis in Pediatric
Talya Wittmann Dayagi1,2, Ronit Nirel3, Galia Avrahami4,2
1Division of Haematology and Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Existing sepsis scoring tools are inadequate for children with cancer or post-stem cell transplant. A new model incorporating unique patient factors significantly improved sepsis risk prediction in this vulnerable group.
Area of Science:
- Pediatric critical care medicine
- Hematology-oncology
- Infectious diseases
Background:
- Children with hemato-oncological diseases or post-stem cell transplantation (SCT) face high risks of severe infections, with sepsis being a major cause of pediatric intensive care unit (PICU) admission.
- Current prognostic scoring tools, like PELOD-2 and PRISM III, are designed for general pediatric populations and may not accurately assess critically ill children with cancer or those who have undergone SCT.
Purpose of the Study:
- To evaluate the accuracy of existing prognostic scoring tools (PELOD-2 and PRISM III) for sepsis in children with hemato-oncological diseases or post-SCT.
- To develop and validate a new, more accurate risk-assessment model tailored to the unique characteristics of this vulnerable patient population.
Main Methods:
- Retrospective analysis of 233 PICU admissions for sepsis in children with hemato-oncological diseases or post-SCT (2008-2021).
- Collected and analyzed demographic, clinical, and laboratory data, including outcomes.
- Assessed the predictive accuracy of PELOD-2 and PRISM III, and developed a new model incorporating novel parameters relevant to this cohort.
Main Results:
- The overall survival rate for the cohort was 83%.
- PELOD-2 and PRISM III showed predictive accuracies (AUC) of 83% and 78%, respectively.
- A new risk-assessment model, incorporating nine significant parameters (age, SCT, viral/fungal infections, central venous line removal, vasoactive inotropic score, bilirubin, CRP, prolonged neutropenia), achieved significantly improved predictive accuracies of 91% and 89% (p<0.01).
Conclusions:
- The PELOD-2 and PRISM III scores have limited predictive accuracy for sepsis in critically ill children with hemato-oncological diseases or post-SCT.
- A tailored risk-assessment tool is needed for this population, accounting for their specific vulnerabilities like immunosuppression.
- Further validation of the new scoring system in a large, multi-center prospective study is recommended.
Abstract:
Background: Children with hemato-oncological diseases or following stem cell transplantation (SCT) are at high risk for life-threatening infections; sepsis in this population constitutes a substantial proportion of pediatric intensive care unit (PICU) admissions. The current pediatric prognostic scoring tools to evaluate illness severity and mortality risk are designed for the general pediatric population and may not be adequate for this vulnerable subpopulation. Methods: Retrospective analysis was performed on all PICU admissions for sepsis in children with hemato-oncological diseases or post-SCT, in a single tertiary pediatric hospital between 2008 and 2021 (n = 233). We collected and analyzed demographic, clinical, and laboratory data and outcomes for all patients, and evaluated the accuracy of two major prognostic scoring tools, the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) and the Pediatric Risk of Mortality III (PRISM III). Furthermore, we created a new risk-assessment model that contains additional parameters uniquely relevant to this population. Results: The survival rate for the cohort was 83%. The predictive accuracies of PELOD-2 and PRISM III, as determined by the area under the curve (AUC), were 83% and 78%, respectively. Nine new parameters were identified as clinically significant: age, SCT, viral infection, fungal infection, central venous line removal, vasoactive inotropic score, bilirubin level, C-reactive protein level, and prolonged neutropenia. Unique scoring systems were established by the integration of these new parameters into the algorithm; the new systems significantly improved their predictive accuracy to 91% (p = 0.01) and 89% (p < 0.001), respectively. Conclusions: The predictive accuracies (AUC) of the PELOD-2 and PRISM III scores are limited in children with hemato-oncological diseases admitted to PICU with sepsis. These results highlight the need to develop a risk-assessment tool adjusted to this special population. Such new scoring should represent their unique characteristics including their degree of immunosuppression and be validated in a large multi-center prospective study.
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