[Predictive value of three scoring systems for pediatric sepsis prognosis: a receiver operator characteristic curve...

To evaluate the value of the Phoenix Sepsis Score (PSS), pediatric Sequential Organ Failure Assessment (pSOFA) and PEdiatric Logistic Organ Dysfunction-2 (PELOD-2) in assessing disease severity and prognosis in children with sepsis.

A retrospective observational study was conducted. A total of 226 pediatric patients with sepsis admitted to pediatric intensive care unit (PICU) of the Affiliated Hospital of Guizhou Medical University from June 2021 to April 2024 were enrolled. The gender, age, body mass index (BMI), site of infection, mechanical ventilation requirement, length of PICU stay, and clinical outcome were extracted, together with the physiological variables required by PSS, pSOFA and PELOD-2 scoring systems. The three critical scores were calculated with the worst values of physiological indicators obtained within 24 hours after PICU admission. According to the 2024 international consensus, children were classified as sepsis (without shock) or septic shock depending on the presence of cardiovascular dysfunction. They were further divided into survivors and non-survivors based on the outcome during PICU hospitalization. Clinical characteristics were compared between the two groups. Receiver operator characteristic curve (ROC curve) was used to assess the ability of the three scoring systems to predict death risk during PICU hospitalization in sepsis without shock and in septic shock, as well as progression from sepsis without shock to septic shock. Decision curve analysis (DCA) was employed to examine the clinical utility of the three scoring systems for predicting death risk during PICU hospitalization in children with sepsis without shock and in those with septic shock, as well as progression from sepsis without shock to septic shock.

A total of 226 pediatric patients with sepsis were ultimately included; 188 (83.2%) survived during PICU hospitalization and 38 (16.8%) died. No significant differences were observed between survivors and non-survivors in gender, age, BMI, site of infection, or length of PICU stay. Non-survivors exhibited higher rates of septic shock and mechanical ventilation, together with higher PSS, pSOFA and PELOD-2 scores, than survivors [septic shock: 84.2% (32/38) vs. 23.4% (44/188), mechanical ventilation: 97.4% (37/38) vs. 24.5% (46/188), PSS score: 7.0 (5.0, 8.3) vs. 3.0 (2.0, 3.0), pSOFA score: 8 (5, 12) vs. 3 (2, 5), PELOD-2 score: 6 (5, 9) vs. 2 (0, 4), all P<0.05]. ROC curve analysis showed that the area under the ROC curve (AUC) of PSS, pSOFA, and PELOD-2 scores for predicting death risk during PICU hospitalization in the pediatric patients with sepsis without shock was 0.924 [95% confidence interval (95%CI) was 0.831-1.000], 0.666 (95%CI was 0.438-0.894), and 0.915 (95%CI was 0.818-1.000), respectively. The AUC of PSS, pSOFA, and PELOD-2 scores for predicting death risk during PICU hospitalization in the pediatric patients with septic shock was 0.863 (95%CI was 0.777-0.950), 0.818 (95%CI was 0.725-0.911), and 0.947 (95%CI was 0.900-0.994), respectively. The AUC of PSS, pSOFA, and PELOD-2 scores for predicting progression from sepsis without shock to septic shock in the pediatric patients was 0.799 (95%CI was 0.731-0.866), 0.777 (95%CI was 0.707-0.847), and 0.793 (95%CI was 0.733-0.856), respectively. DCA curve showed that when the death risk threshold during PICU hospitalization in the pediatric patients with sepsis without shock reached 0.3, the net benefit of the three scoring systems as triggers for emergency intervention ranked PSS score (0.212) >PELOD-2 score (0.177) >pSOFA score (0.074). When the death risk threshold during PICU hospitalization in the pediatric patients with septic shock reached 0.3, the net benefit of the three scoring systems as triggers for emergency intervention ranked PELOD-2 score (0.213) >PSS score (0.174) >pSOFA score (0.124). When the risk threshold of progression from sepsis without shock to septic shock in the pediatric patients reached 0.3, the net benefit of the three scoring systems as triggers for emergency intervention ranked PSS score (0.159) >pSOFA score (0.131) >PELOD-2 score (0.117).

PSS and PELOD-2 scores demonstrate high value for predicting poor outcomes during PICU hospitalization in children with sepsis without shock, with PSS score performing best. PSS, pSOFA and PELOD-2 scores show high predictive value for poor prognosis during PICU hospitalization in septic shock, among which PELOD-2 score performs best. The predictive value of the three scoring systems for progression from sepsis without shock to septic shock is moderate.