Prediction of attributable mortality in pediatric patients with cancer admitted to the intensive care unit for suspected infection: A comprehensive evaluation of risk scores

Abstract

ObjectiveTo evaluate the performance of existing sepsis scores for prediction of adverse outcomes in children with cancer admitted to the ICU with suspected sepsis.DesignRetrospective chart review using data available at 1, 6, 12, and 24 h after ICU admission to calculate the Pediatric Risk of Mortality 3 (PRISM‐3), Pediatric Sequential Organ Failure Assessment (pSOFA), Paediatric Logistic Organ Dysfunction 2 (PELOD‐2), and Quick Pediatric Sequential Organ Failure Assessment (qSOFA) scores.Area under the receiver operator characteristic curve (AUROC) was used to evaluate performance for prediction of attributable mortality. Sensitivity analyses included recalculation of scores using worst preceding values for each variable, excluding hematologic parameters, and prediction of alternative outcomes.SettingSt. Jude Children's Research Hospital, a pediatric comprehensive cancer center in the USA.PatientsPediatric patients (<25 years of age) receiving conventional therapy for cancer admitted to the ICU with suspected sepsis between 2013 and 2019.ResultsOf 207 included episodes of suspected sepsis, attributable mortality was 16 (7.7%) and all evaluated sepsis scores performed poorly (maximal AUROC of 0.73 for qSOFA at 1 and 24 h). Sensitivity analyses did not identify an alternative approach that significantly improved prediction.ConclusionsCurrently available sepsis scores perform poorly for prediction of attributable mortality in children with cancer who present to ICU with suspected sepsis. More research is needed to identify reliable predictors of adverse outcomes in this population.

Phoenix Sepsis Score and Risk of Attributable Mortality in Children With Cancer

“…We used an existing retrospective cohort to evaluate the Phoenix Sepsis Score in children receiving treatment for cancer admitted to the intensive care unit (ICU) with suspected infection; the performance of Pediatric Risk of Mortality 3 (PRISM3), Pediatric Sequential Organ Failure Assessment (pSOFA), quick SOFA (qSOFA), and Paediatric Logistic Organ Dysfunction 2 (PELOD2) scores have been previously described. 1 Briefly, we collected data for patients receiving cancer therapy (excluding hematopoietic cell therapy [HCT]), admitted to the ICU at St Jude Children’s Research Hospital between 2013 to 2019 with suspected infection. We calculated the Phoenix Sepsis Score using worst values recorded within 24 hours after the ICU admission, and then recalculated excluding platelet count (PHO-Phoenix).…”

“… 4 We estimated area under the receiver operating characteristic curve (AUROC) for classification of outcomes, including attributable mortality, definitely attributable mortality, all-cause mortality, and prolonged ICU stay (ie, more than 7 days). 1 , 5 AUROCs were numerically compared with PRISM3, pSOFA, qSOFA, and PELOD2 scores. 1 Additional methods are included in the eMethods in Supplement 1 .…”

“… 1 , 5 AUROCs were numerically compared with PRISM3, pSOFA, qSOFA, and PELOD2 scores. 1 Additional methods are included in the eMethods in Supplement 1 . Data were analyzed from January to February 2024.…”

“…Children receiving treatment for cancer are at high risk of sepsis-related death. 1 , 2 In patients with sepsis, identifying those at greatest mortality risk is essential to target interventions, research, and counseling. 3 However, general pediatric sepsis scoring systems perform poorly in children with cancer in high-income countries.…”

“… 3 However, general pediatric sepsis scoring systems perform poorly in children with cancer in high-income countries. 1 , 3 This might be due to differences in clinical presentation or pathways to attributable death.…”