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Published on: January 16, 2019
Predictive Value of PRISM-4, PIM-3, CRP, Albumin, CRP/Albumin Ratio and Lactate in Critically Ill Children
Gazi Arslan1, Tolga Besci1, Göktuğ Özdemir1
1Department of Pediatrics, Division of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylül University, Konak 35220, Turkey.
Insights
Predicting outcomes for critically ill children is vital. New research suggests incorporating albumin and lactate levels into existing scoring systems like PIM and PRISM could improve mortality prediction accuracy.
Area of Science:
- Pediatric critical care medicine
- Biomarker research
- Prognostic modeling
Background:
- Accurate prognosis prediction for critically ill children is essential.
- Existing scoring systems like PIM and PRISM lack certain key biological markers.
- Albumin, CRP, and lactate levels reflect inflammation and circulatory status but are not integrated into current models.
Purpose of the Study:
- To evaluate the association between biological markers (albumin, CRP, lactate) and clinical outcomes in critically ill children.
- To assess the predictive accuracy of these markers compared to established scoring systems (PIM-3, PRISM-4).
- To determine if incorporating these markers can enhance mortality prediction.
Main Methods:
- Retrospective cohort study of 942 critically ill children.
- Recorded PRISM-4 and PIM-3 death probability (DP), albumin, lactate, CRP, and CRP/albumin ratio at admission.
- Assessed predictive accuracy using the area under the curve (AUC).
Main Results:
- The 28-day mortality rate was 7.9%.
- AUC values were: PRISM-4 (0.923), PIM-3 (0.896), CRP (0.798), CRP/albumin ratio (0.795), albumin (0.751), and lactate (0.728).
- Subgroup analysis in septic patients yielded similar results.
Conclusions:
- While CRP and CRP/albumin ratio showed predictive value, albumin and lactate demonstrated higher accuracy.
- Albumin and lactate levels are linked to mortality in critically ill children.
- Integrating albumin and lactate into existing scoring systems has the potential to improve prognostic predictability.
Abstract:
The accurate prediction of the prognosis for critically ill children is crucial, with the Pediatric Index of Mortality (PIM) and Pediatric Risk of Mortality (PRISM) being extensively utilized for this purpose. Albumin, C-reactive protein (CRP), and lactate levels, which are indicative of inflammation and circulatory status in critically ill children, have not been incorporated into existing scoring systems. This retrospective cohort study evaluated the association between biological markers and the clinical outcomes in children with critical illnesses. PRISM-4 and PIM-3 death probability (DP), albumin, lactate, CRP, and CRP/albumin ratio were recorded upon admission. The accuracy of the indexes in predicting mortality were assessed by calculating the area under the curve (AUC). There were 942 patients included and the 28-day mortality rate was 7.9%. The AUC for PRISM-4, PIM-3, CRP, CRP/albumin ratio, albumin, and lactate were 0.923, 0.896, 0.798, 0.795, 0.751, 0.728, respectively. The findings in the subgroup analysis of septic patients were similar to those found in the overall population. Although CRP, CRP/albumin ratio, albumin, and lactate levels are all linked to mortality in children, CRP and the CRP/albumin ratio have lower predictive values than albumin and lactate. Incorporation of albumin and lactate into scoring systems will improve predictability.
