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Prognostic Accuracy of Serially Measured Organ Dysfunction Scores in Children with Fluid Refractory Septic Shock
Ritu Sharma1, Arpita Chattopadhyay2, Diganta Saikia1
1Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, 110031, India.
Insights
Serial assessment of PEdiatric Logistic Organ Dysfunction (PELOD)-2 and pediatric Sequential Organ Failure Assessment (pSOFA) scores improves prediction of mortality in pediatric septic shock. The PELOD-2 score showed higher accuracy, particularly on day 4 of pediatric intensive care unit admission.
Area of Science:
- Pediatric critical care medicine
- Septic shock research
- Prognostic scoring systems
Background:
- Pediatric septic shock carries a high mortality risk.
- Accurate prognostic tools are crucial for timely intervention.
- Fluid-refractory septic shock presents unique management challenges.
Purpose of the Study:
- To compare the prognostic accuracy of serially measured PELOD-2 and pSOFA scores.
- To evaluate their ability to predict 28-day in-hospital mortality.
- To assess score performance in pediatric fluid-refractory septic shock.
Main Methods:
- Prospective enrollment of children (<12 years) with fluid-refractory septic shock.
- Serial calculation of PELOD-2 and age-adapted pSOFA scores over 4 days.
- Comparison of scoring systems using Area Under the Receiver Operating Characteristic Curve (AUROC) analysis.
Main Results:
- The sensitivity of PELOD-2 for mortality prediction increased from 60.5% on day 1 to 84.2% on day 4.
- pSOFA sensitivity rose from 47.4% to 63.2% over the same period.
- Both scores showed improved discriminative power over time, with adjusted AUROC for PELOD-2 reaching 0.90 on day 4.
Conclusions:
- Serially assessed PELOD-2 and pSOFA scores enhance prognostic accuracy for 28-day mortality in pediatric septic shock.
- Prognostic performance significantly improves when scores are assessed on day 4 versus admission.
- PELOD-2 demonstrated superior discriminative ability compared to pSOFA in this cohort.
Objectives:
To evaluate the prognostic accuracy of serially measured PEdiatric Logistic Organ Dysfunction (PELOD)-2 and pediatric Sequential Organ Failure Assessment (pSOFA) scores for predicting 28-day in-hospital mortality in pediatric fluid-refractory septic shock.
Methods:
Children aged < 12 years admitted to the pediatric intensive care unit (PICU) with fluid-refractory septic shock were enrolled. PELOD-2 and age-adapted pSOFA scores were compared using crude and adjusted area under the receiver operating characteristic curve (AUROC) analysis over the first four days of PICU admission.
Results:
Of the 93 children analyzed, 38 (40.9%) died, and 45 (48.4%) experienced a PICU length of stay ≥ 7 days. The sensitivity of PELOD-2 (score ≥ 8) to predict 28-day in-hospital mortality increased from 60.5 on day 1 to 84.2% on day 4, whereas that of pSOFA (score ≥ 8) increased from 47.4 to 63.2%. Discriminative power improved over time, with adjusted AUROC for mortality prediction increasing from day 1 to day 4 for both PELOD-2 (0.69 to 0.90) and pSOFA (0.69 to 0.88).
Conclusions:
In children with fluid-refractory septic shock, PELOD-2 and pSOFA scores demonstrated increasing prognostic accuracy for 28-day in-hospital mortality when assessed serially, with better discrimination on day 4 compared with baseline scores at admission.
