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

Shin Tsubokura1, Norihiko Tsuboi1, Saki Endo1

  • 1Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|July 13, 2026
PubMed

Insights

Combining the pediatric sequential organ failure assessment (pSOFA) score and persistent inflammation, immunosuppression, and catabolism syndrome in pediatrics (PIICS-p) criteria improves mortality risk stratification in critically ill children. This approach identifies high-risk patients early and predicts late mortality.

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.
Abstract

Keywords:
child mortalitycritical illnessintensive care unitsorgan dysfunction scoresprediction algorithms

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