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Validating the performance of organ dysfunction scores in children with infection: A cohort study
Shaojun Li1,2, Tao Tan3, Jing Li2,4
1Emergency Department, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.
Insights
The pediatric SOFA (pSOFA) and PELOD2 scores effectively predict hospital mortality in children with infections. The pSOFA score is recommended for assessing organ dysfunction in pediatric sepsis.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Clinical scoring systems
Background:
- Pediatric sepsis and severe infections are significant causes of mortality.
- Accurate prediction of mortality is crucial for timely intervention and resource allocation.
- Several scoring models exist, but their performance in pediatric populations requires validation.
Purpose of the Study:
- To validate the performance of six established scoring models in predicting hospital mortality among children with suspected or confirmed infections.
- To compare the predictive accuracy and clinical utility of different scoring systems.
Main Methods:
- A single-center retrospective cohort study involving pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) for infection.
- Inclusion of 5,356 patients, with hospital mortality as the primary outcome.
- Evaluation of six scoring models: age-adapted pSOFA, SIRS, PELOD2, Sepsis-2, qSOFA, and PMODS.
Main Results:
- The pediatric Sequential Organ Failure Assessment (pSOFA) and Pediatric Logistic Organ Dysfunction-2 (PELOD2) scores demonstrated superior discrimination abilities compared to other models.
- Calibration analysis showed good agreement between predicted and observed mortality for pSOFA and PELOD2.
- Elevated lactate levels were identified as a significant risk factor for mortality in this cohort.
Conclusions:
- The pSOFA and PELOD2 scores exhibit superior predictive performance for hospital mortality in critically ill children with infections.
- The pSOFA score is recommended as an optimal, clinically operable tool for assessing acute organ dysfunction in pediatric sepsis.
- Elevated lactate levels are strongly associated with an increased risk of death in pediatric PICU patients with infections.
Purpose:
We aimed to validate the performance of six available scoring models for predicting hospital mortality in children with suspected or confirmed infections.
Methods:
This single-center retrospective cohort study included pediatric patients admitted to the PICU for infection. The primary outcome was hospital mortality. The six scores included the age-adapted pSOFA score, SIRS score, PELOD2 score, Sepsis-2 score, qSOFA score, and PMODS.
Results:
Of the 5,356 children admitted to the PICU, 9.1% (488) died, and 25.1% (1,342) had basic disease with a mortality rate of 12.7% (171); 65.3% (3,499) of the patients were younger than 2 years, and 59.4% (3,183) were male. The discrimination abilities of the pSOFA and PELOD2 scores were superior to those of the other models. The calibration curves of the pSOFA and PELOD2 scores were consistent between the predictions and observations. Elevated lactate levels were a risk factor for mortality.
Conclusion:
The pSOFA and PELOD2 scores had superior predictive performance for mortality. Given the relative unavailability of items and clinical operability, the pSOFA score should be recommended as an optimal tool for acute organ dysfunction in pediatric sepsis patients. Elevated lactate levels are related to a greater risk of death from infection in children in the PICU.
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