A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis

Abstract

IntroductionThe aim of this study was to derive a novel prognostic score for mortality in paediatric meningococcal sepsis (MS) based on readily available laboratory markers.MethodsA multicentre retrospective cohort study for the consortium set and a single centre retrospective study for replication set. The consortium set were 1,073 children (age 1 week to 17.9 years) referred over a 15-year period (1996 to 2011), who had an admission diagnosis of MS, referred to paediatric intensive care units (PICUs) in six different European centres. The consortium set was split into a development set and validation set to derive the score. The replication set were 134 children with MS (age 2 weeks to 16 years) referred over a 4-year period (2007 to 2011) to PICUs via the Children's Acute Transport Service (CATS), London.ResultsA total of 85/1,073 (7.9%) children in the consortium set died. A total of 16/134 (11.9%) children in the replication set died. Children dying in the consortium set had significantly lower base excess, C-reactive protein (CRP), platelet and white cell count, more deranged coagulation and higher lactate than survivors. Paediatric risk of mortality (PRISM) score, Glasgow meningococcal septicaemia prognosis score (GMSPS) and Rotterdam score were also higher. Using the consortium set, a new scoring system using base excess and platelet count at presentation, termed the BEP score, was mathematically developed and validated. BEP predicted mortality with high sensitivity and specificity scores (area under the curve (AUC) in the validation set = 0.86 and in the replication set = 0.96). In the validation set, BEP score performance (AUC = 0.86, confidence interval (CI): 0.80 to 0.91) was better than GMSPS (AUC = 0.77, CI: 0.68, 0.85), similar to Rotterdam (AUC = 0.87, CI: 0.81 to 0.93) and not as good as PRISM (AUC = 0.93, CI: 0.85 to 0.97).ConclusionsThe BEP score, relying on only two variables that are quickly and objectively measurable and readily available at presentation, is highly sensitive and specific in predicting death from MS in childhood.

Plastic and Orthopaedic Interventions and Long-Term Sequelae in Children with Meningococcal Septicemia—40 Years of Experience at the University Children's Hospital Zurich

“…Several different scoring systems to assess the severity and lethality of meningococcal septicemia can be found in the literature. The most common one is probably the Glasgow Meningococcal Sepsis Prognostics Score (GMSPS) 17,18 or the use of the Pediatric Risk of Mortality (PRISM), 17,19 which is not restricted to meningococcal septicemia. The GMSPS involves Amputation (% of children within the group) 0 (0) 1 (9) 0 (0) 14 (23) Orthopaedic sequelae (% of children within the group) 0 (0) 1 (9) 0 (0) 9 (15) Abbreviation: PICU, pediatric intensive care unit.…”

Doença Meningocócica Invasiva: Aplicação do Base Excess and Platelets Score numa Unidade de Cuidados Intensivos Pediátricos Portuguesa

“…3,20 O score que revelou melhor precisão foi o PRISM seguido do PIM 2 . O BEP score também demonstrou uma boa precisão, apesar de não tão elevada como os outros scores estudados.…”

“…[3][4][5] Existem scores de prognóstico, validados para doença meningocócica invasiva (DMI) que combinam dados clínicos e laboratoriais. Nestes estão incluídos o Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS), 6 e scores genéricos para cuidados intensivos pediátri-cos como o Paediatric Risk of Mortality (PRISM) 7 e o Martins L, et al Doença meningocócica invasiva: aplicação do BEP score, Acta Med Port 2015 May-Jun;28(3):342-346…”

“…9 Um score ideal deve incluir um número mínimo de variáveis, que possam ser rápida e objetivamente mensurá-veis, na apresentação da doença e ser custo-efetivas. 3 É importante ter em conta que alguns scores, como o PRISM ou o GMSPS, usam dados clínicos, estando dependentes de uma avaliação que é subjetiva em muitos aspetos, o que pode reduzir a sua fiabilidade. 3,6,7 Recentemente foi desenvolvido e validado um novo score prognóstico por um grupo de investigadores de vá-rios centros europeus de cuidados intensivos pediátricos, baseado na contagem plaquetar e no excesso de base, o BEP score (base excess and platelets).…”

Circadian Variation of Plasminogen-Activator-Inhibitor-1 Levels in Children with Meningococcal Sepsis

“…Illness severity was indicated by the probability of death based on the BEP score (P (death BEP)) [12], DIC score [13], and Pediatric Risk of Mortality (PRISM) [14]. Quantitative variables are presented either as mean (±SD) when normally distributed or as median (IQR).…”