Mortality Stratification With Pediatric SOFA and Persistent Inflammation, Immunosuppression, and Catabolism Syndrome

Area of Science:

• Pediatric critical care medicine
• Clinical risk stratification
• Prognostic modeling

Background:

• Persistent inflammation, immunosuppression, and catabolism syndrome in pediatrics (PIICS-p) criteria identify pediatric intensive care unit (PICU) patients with poor long-term prognosis.
• Pediatric sequential organ failure assessment (pSOFA) score is a validated predictor of short-term mortality in critically ill children.

Purpose of the Study:

• To evaluate the combined utility of pSOFA score and PIICS-p criteria for comprehensive risk stratification in critically ill children.
• To determine if integrating these measures improves prediction of mortality compared to using them individually.

Main Methods:

• A retrospective cohort study included 285 pediatric patients with prolonged PICU stays (≥15 days).
• Patients were assessed on PICU day 14 for high (>8) or low pSOFA scores and stratified by the presence or absence of PIICS-p criteria.
• Primary outcomes included in-hospital mortality and time from PICU day 14 to death.

Main Results:

• Overall mortality was 47% in the high pSOFA group, 32% in the low pSOFA/PIICS-p group, and 10% in the low pSOFA/non-PIICS-p group (p < 0.001).
• High pSOFA (HR 6.33) and low pSOFA/PIICS-p (HR 3.14) were significant independent risk factors for mortality.
• Kaplan-Meier survival analysis revealed significant differences among the three risk groups, with distinct early and late mortality patterns.

Conclusions:

• The integration of pSOFA score and PIICS-p criteria effectively stratifies critically ill children into three distinct mortality risk groups.
• This combined approach allows for early identification of patients at high risk for both short-term and late mortality, even among those initially appearing to have a low acute risk.