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Dynamic Prediction of Mortality Using Longitudinally Measured Pediatric Sequential Organ Failure Assessment Scores: A
Alireza Akhondi-Asl1,2,3,4, Alon Geva1,2,3,4, Jeffrey P Burns1,2,3,4
1Division of Critical Care Medicine, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA.
Insights
Longitudinal pediatric Sequential Organ Failure Assessment (pSOFA) scores, tracking changes over time, significantly improve mortality prediction in critically ill children compared to static admission scores. This dynamic approach offers a more accurate assessment of patient condition and response to treatment in the PICU.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
- Biostatistics
Background:
- The pediatric Sequential Organ Failure Assessment (pSOFA) score is crucial for assessing illness severity and predicting mortality in critically ill children.
- Current static pSOFA assessments at a single point in time fail to capture patient condition changes and treatment response during Pediatric Intensive Care Unit (PICU) stays.
- A dynamic approach is needed to improve the accuracy of mortality prediction in pediatric critical care.
Purpose of the Study:
- To evaluate the performance of longitudinal (time-varying) pSOFA scores for predicting 30-day in-hospital mortality in critically ill children.
- To compare the predictive accuracy of dynamic pSOFA scoring with the traditional static admission pSOFA score.
Main Methods:
- Retrospective cohort study involving 9146 patients admitted to a quaternary 40-bed PICU between 2015 and 2021 with at least 24 hours of ICU stay.
- Daily pSOFA scores were calculated up to 30 days or until discharge/death.
- A joint longitudinal and time-to-event data model was used for dynamic mortality prediction, with the dataset randomly split into training (75%) and validation (25%) subsets, utilizing repeated stratified cross-validations.
Main Results:
- The study dataset included 9146 patients with a 30-day in-hospital mortality rate of 2.6%.
- Longitudinal pSOFA scores from the first 3 days improved the dynamic area under the curve (AUC) for mortality prediction by 6.4% compared to admission scores.
- Utilizing longitudinal pSOFA scores from the first 5 days further enhanced AUC by 9.2% for mortality prediction between days 5 and 30.
Conclusions:
- Longitudinal pSOFA scores demonstrate superior accuracy in predicting mortality among PICU patients compared to the traditional admission-day pSOFA score.
- The dynamic application of pSOFA scores holds significant potential for more precise and continuous evaluation of patient conditions in critical care settings.
- This study highlights the value of dynamic risk assessment in pediatric critical care for improved patient outcomes.
Objectives:
The pediatric Sequential Organ Failure Assessment (pSOFA) score was designed to track illness severity and predict mortality in critically ill children. Most commonly, pSOFA at a point in time is used to assess a static patient condition. However, this approach has a significant drawback because it fails to consider any changes in a patients' condition during their PICU stay and, especially, their response to initial critical care treatment. We aimed to evaluate the performance of longitudinal pSOFA scores for predicting mortality.
Design:
Single-center, retrospective cohort study.
Setting:
Quaternary 40-bed PICU.
Patients:
All patients admitted to the PICU between 2015 and 2021 with at least 24 hours of ICU stay.
Interventions:
None.
Measurements And Main Results:
We calculated daily pSOFA scores up to 30 days, or until death or discharge from the PICU, if earlier. We used the joint longitudinal and time-to-event data model for the dynamic prediction of 30-day in-hospital mortality. The dataset, which included 9146 patients with a 30-day in-hospital mortality of 2.6%, was divided randomly into training (75%) and validation (25%) subsets, and subjected to 40 repeated stratified cross-validations. We used dynamic area under the curve (AUC) to evaluate the discriminative performance of the model. Compared with the admission-day pSOFA score, AUC for predicting mortality between days 5 and 30 was improved on average by 6.4% (95% CI, 6.3-6.6%) using longitudinal pSOFA scores from the first 3 days and 9.2% (95% CI, 9.0-9.5%) using scores from the first 5 days.
Conclusions:
Compared with admission-day pSOFA score, longitudinal pSOFA scores improved the accuracy of mortality prediction in PICU patients at a single center. The pSOFA score has the potential to be used dynamically for the evaluation of patient conditions.
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