Early prediction of impending septic shock in children using age-adjusted Sepsis-3 criteria

Abstract

Sepsis is a syndrome which afflicts both adults and children, with many disease courses and diverse outcomes. Understanding of sepsis pathophysiology has changed over time; the Sepsis-3 criteria define sepsis in adults as organ dysfunction, quantified by SOFA score, caused by dysregulated immune response to infection. However, pediatric consensus definitions still utilize the SIRS-based Sepsis-2 criteria, though individual groups have attempted to adapt the Sepsis-3 criteria for children. We evaluate age-adjusted Sepsis-3 criteria on 2,384 pediatric patients admitted to the Johns Hopkins PICU, and apply previously-published methods for early prediction of septic shock. We obtain best early prediction performance of 0.96 AUC, 49.9% overall PPV, and a 5.8-hour median EWT using Sepsis-3 labels based on age-adjusted SOFA score. Through analyses of risk score evolution over time, we corroborate our past finding of an abrupt transition preceding onset of septic shock in children, and are able to stratify pediatric sepsis patients using their first post-threshold-crossing risk score.