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

In the previous study, persistent inflammation, immunosuppression, and catabolism syndrome in pediatrics (PIICS-p) criteria identified a subgroup with poor long-term prognosis. Pediatric sequential organ failure assessment (pSOFA) score is a well-known predictor of short-term mortality. We hypothesized that combining the pSOFA score and PIICS-p criteria could provide more comprehensive risk stratification.

We conducted a retrospective cohort study in a PICU. Included were 285 eligible patients aged zero to 19 years with 15 days or longer of PICU stay between January 2019 and December 2023. The primary outcomes were death during the observation period and time from PICU day 14 to death. Patients were classified on PICU day 14: high pSOFA (> 8) or low, subsequently stratified by PIICS-p or not.

The overall mortality rate was 47% (35/75) in high pSOFA, 32% (8/25) in low pSOFA/PIICS-p, and 10% (18/185) in low pSOFA/non-PIICS-p group (p < 0.001). In a multivariable Cox proportional hazards model, high pSOFA (HR 6.33, 95% CI 3.43-11.7, p < 0.001) and low pSOFA/PIICS-p (HR 3.14, 95% CI 1.28-7.69, p = 0.012) were identified as significant risk factors for mortality. The Kaplan-Meier curves showed significant differences among the three groups (p < 0.001). The high pSOFA group showed an early decline in survival. Survival in the low pSOFA/PIICS-p group was lower than that in the low pSOFA/non-PIICS-p group, and the difference widened over time.

Integration of pSOFA and PIICS-p enables three-group mortality stratification in critically ill children and early recognition of late-mortality risk among those who appear low risk acutely.