Accuracy Comparison Between Age-Adapted SOFA and SIRS in Predicting in-Hospital Mortality of Infected Children at China's PICU

Abstract

Objectives: Sepsis-3 consensus suggests “the need to develop similar updated definitions for pediatric populations.” Sequential organ failure assessment (SOFA) and systemic inflammatory response syndrome (SIRS) criteria are two systems widely used to define the status of infection. However, it is still unclear whether SOFA is more accurate than SIRS in predicting children mortality in low- and middle-income countries. Thus, we validated the accuracy of age-adapted SOFA and SIRS in predicating the poor prognosis of infected children in China's pediatric intensive care unit (PICU). Methods: We performed a retrospective and observational cohort study of children admitted for infection to PICU in the hospital between January 1, 2009 and December 31, 2017. The indexes within 24 h after intensive care unit (ICU) admission were analyzed according to age-adapted SOFA and SIRS, and all data were sourced from the hospital's electronic health record database. The prognosis was illustrated with primary outcome and secondary outcome. Primary outcome referred to in-hospital mortality, and secondary outcome to in-hospital mortality or ICU length of stay ≥ 7 days. The predictive power of age-adapted SOFA and SIRS was compared using crude and adjusted area under the receiver operating characteristic curve (AUROC). Results: Of 1,831 PICU-admitted children due to infection, 164 (9.0%) experienced primary outcome, and 948 (51.8%) secondary outcome. Of 164 deaths, 65.9% were males (median age of 7.53 months, range of 2.67–41.00 months). Children who scored ≥ 2 in age-adapted SOFA or met two SIRS criteria accounted for 92.5% and 73.3%, respectively. In addition, age-adapted SOFA score of ≥2 predicted adverse outcome more accurately than pediatric SIRS (adjusted AUROC, 0.753; 0.713–0.796 vs. 0.674; 0.631–0.702; P < 0.001). Conclusion: Compared with SIRS criteria, age-adapted SOFA score of ≥ 2 enjoys a more accuracy in predicting in-hospital mortality of PICU-admitted children, and a higher sensitivity in identifying children with severe infection.

Accuracy of SIRS, age-adapted pSOFA, and quick SOFA scoring systems for predicting outcomes in paediatric patients with sepsis: a meta-analysis

“…These findings are in accordance with previous studies also examining the ability of the two scoring systems for predicting mortality in children with sepsis or those admitted for infection. 8,10,13 This is consistent with another large retrospective study featuring 8711 PICU patients. 7 The pSOFA scoring system, relative to PRISM, is advantageous because it contains fewer parameters (six vs. fourteen).…”

“…Infection is still the most serious health concern in paediatric patients, which accounts for approximately 10% of the fatalty rate among children admitted to PICU for serious infection. 8 Accurate diagnosis and prognosis are the first two steps to decreasing sepsis-associated mortality in paediatric patients. There are several scoring systems for the prediction of mortality in PICU patients, like PRISM-3, PELOD-2, PIM-3, pSOFA, qSOFA and SIRS.…”

“…Eleven studies reported information on the predictive capability of age-adapted pSOFA scores, 8e18 six studies reported on SIRS, 1,8,13,17e19 and four studies reported on qSOFA. 13,14,19,20,21 Concerning geographic distribution, five studies were conducted in China, 8,11,12,14,18 two in the UK 19,20 and South Korea, 22,23 one multicentric (Canada, USA and Uganda), 1 and one each was conducted in India, 9 Egypt, 10 Australia, 13 Europe, 15 Iran, 16 and Indonesia 17 (Table 1). The description of scoring system is shown in Supplementary Table 1.…”

A National Approach to Pediatric Sepsis Surveillance

“…26 Authors of recently published studies and commentaries support applying Sepsis-3 to pediatrics but note the importance of considering the unique physiology of infants and children. [27][28][29][30][31][32][33][34][35][36][37] As in adults, new or progressive organ failure is associated with higher mortality in children with suspected infections. 31 Likewise, SIRS is common in febrile children who are otherwise well and correlates poorly with the presence of infection or sepsis.…”

Clinical Decision-Support Systems for Detection of Systemic Inflammatory Response Syndrome, Sepsis, and Septic Shock in Critically Ill Patients: A Systematic Review

“…Moreover, recent studies evaluating different sepsis scores with regard to mortality reported that SIRS criteria have lower accuracy compared with SOFA, qSOFA, or MEWS (Modified Early Warning Score). [69][70][71] Consequently, evaluating SIRS criteria for prediction of mortality seems like the wrong approach. However, the big advantage of SIRS criteria for recognizing deterioration on a very early point in time has been overlooked lately.…”