Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis

Abstract

Background Scores can assess the severity and course of disease and predict outcome in an objective manner. This information is needed for proper risk assessment and stratification. Furthermore, scoring systems support optimal patient care, resource management and are gaining in importance in terms of artificial intelligence. Objective This study evaluated and compared the prognostic ability of various common pediatric scoring systems (PRISM, PRISM III, PRISM IV, PIM, PIM2, PIM3, PELOD, PELOD 2) in order to determine which is the most applicable score for pediatric sepsis patients in terms of timing of disease survey and insensitivity to missing data. Methods We retrospectively examined data from 398 patients under 18 years of age, who were diagnosed with sepsis. Scores were assessed at ICU admission and re-evaluated on the day of peak C-reactive protein. The scores were compared for their ability to predict mortality in this specific patient population and for their impairment due to missing data. Results PIM (AUC 0.76 (0.68–0.76)), PIM2 (AUC 0.78 (0.72–0.78)) and PIM3 (AUC 0.76 (0.68–0.76)) scores together with PRSIM III (AUC 0.75 (0.68–0.75)) and PELOD 2 (AUC 0.75 (0.66–0.75)) are the most suitable scores for determining patient prognosis at ICU admission. Once sepsis is pronounced, PELOD 2 (AUC 0.84 (0.77–0.91)) and PRISM IV (AUC 0.8 (0.72–0.88)) become significantly better in their performance and count among the best prognostic scores for use at this time together with PRISM III (AUC 0.81 (0.73–0.89)). PELOD 2 is good for monitoring and, like the PIM scores, is also largely insensitive to missing values. Conclusion Overall, PIM scores show comparatively good performance, are stable as far as timing of the disease survey is concerned, and they are also relatively stable in terms of missing parameters. PELOD 2 is best suitable for monitoring clinical course.

Meta-Analysis for the Prediction of Mortality Rates in a Pediatric Intensive Care Unit Using Different Scores: PRISM-III/IV, PIM-3, and PELOD-2

“…The study flow diagram is shown in Figure 1 . A total of 29 studies were included for quantitative synthesis, among them, 18 studies that reported on the scoring systems PRISM-III/IV, ( 3 , 4 , 11 , 14 – 21 , 23 – 27 , 37 ), 11 studies that reported data on PIM-3 ( 3 , 4 , 7 , 14 , 16 , 18 , 20 , 28 – 31 ), and nine studies that reported data on PELOD-2 ( 5 , 14 , 16 , 28 , 32 – 36 ). Four studies were reported from India ( 4 , 7 , 17 , 34 ), two from Australia ( 20 , 32 ), two from China ( 20 , 32 ), two from Egypt ( 15 , 18 ), one from Pakistan ( 19 , 26 ), two from Korea ( 14 , 36 ), one from Mexico ( 21 ), one from Singapore ( 28 ), one from UAE ( 29 ), one from Indonesia ( 30 ), one from Africa ( 33 ), one from Saudi Arabia ( 11 ), two from Turkey ( 22 , 24 ), one from Sweden ( 23 ), one from Brazil ( 37 ), one from Switzerland ( 5 ), one from Thailand ( 27 ), one from Italy ( 31 ), and one multi-centric ( 25 ).…”

“…A study reported by Zhong et al ( 32 ) reported that the PELOD-2 score was effective to assess the prognosis of PICU patients with sepsis and has shown an excellent discriminatory power with 0.916. On the other hand, PRISM-III/IV score and PELOD-2 performance becomes better when sepsis is pronounced ( 16 ). Another study reported by Mathews et al showed that the PELOD-2 score of over 20 was able to predict mortality in 72.2% of PICU patients, and the cut-off score >16 showed a sensitivity of 100% and specificity of 54.1% ( 40 ).…”

Performance of Pediatric Index of Mortality PIM-3 in a Tertiary Care PICU in India

“…They reported fair discriminating ability (AUROC, 95% CI) of PIM (0.76 [0.68-0.76]), PIM-2 (0.78 [0.72-0.78]), PIM-3 (0.76 [0.68-0.76)]), PRSIM-III (0.75 [0.68-0.75]), and PELOD-2 (0.75 [0.66-0.75]), while PELOD-2 (AUROC-0.84[0.77-0.91]) and PRISM-IV (AUROC 0.8[0.72-0.88]) had good discriminative ability. 35 Some limitations of our study must be addressed. Since this is a single-center retrospective study with a small sample size, the results may not generalize to other centers or populations.…”

Characteristics of continuous venovenous hemodiafiltration in the acute treatment of inherited metabolic disorders

“…PIM, PIM2, and PIM3 scores, together with PRSIM III and PELOD 2, provided the most suitable indications of mortality, while PRISM provided the poorest mortality prediction of all the tested scores [ 25 ]. Based on the daily estimation of the severity of multiple organ dysfunction syndromes in critically ill children, a high PELOD score (≥ 20 points) was associated with a mortality rate of 40.7%, and a low PELOD score (< 10 points) was associated with a mortality rate of < 1% on the first day of PICU admission [ 26 ].…”