Prevalence of Sepsis as Defined by Phoenix Sepsis Definition Among Children With COVID-19

A retrospective cohort study on patients aged < 18 years included in the Society of Critical Care Medicine: Viral Infection and Respiratory Illness Universal Study registry from March 2020 to April 2024 with an objective of calculating the prevalence of sepsis as defined by the Phoenix Sepsis Score (PSS) and to validate the PSS with respect to outcomes in children with COVID-19.

Linear mixed-effects regression was used to examine the relationship between the PSS and hospital length of stay after controlling for confounding factors. The performance of the PSS was assessed using the receiver operating characteristic (ROC) and the precision-recall curve (PRC). Cross-validation was performed using leave-one-out cross-validation.

Out of 1731 patients (58 hospitals), 326 (18.8%) met criteria for sepsis and 167 (9.7%) for septic shock. The overall mortality was 1.4% (25/1731), with significant differences between nonseptic (10/1405, 0.7%) and both sepsis (15/326, 4.6%) and septic shock (9/167, 5.4%) groups. After adjusting for confounders, the septic group was associated with a longer hospital length of stay than the nonseptic group. One unit increase in the numeric PSS led to a 70% increase in risk of mortality (odds ratio 1.70; P < .001). The area under the ROC curve was 0.80 and the area under the PRC curve was 0.13. The threshold of ≥ 2 for detection of mortality had a sensitivity of 0.63, specificity of 0.82, and positive predictive value of 0.05.

Phoenix Sepsis Criteria retain its validity in identifying sepsis in children with COVID-19 and can be used in further epidemiological studies in this population.