Severe sepsis criteria, PELOD-2, and pSOFA as predictors of mortality in critically ill children with sepsis

Abstract

Background Sepsis is one of the main causes of death in infants and children. Currently, it is defined as a life-threatening organ dysfunction, caused by an inflammatory response of infection. Several organ dysfunction assessment methods are available, but they are not uniformly used.
 Objective To compare the accuracy of three mortality predictor tools: severe sepsis criteria, pediatric logistic organ dysfunction (PELOD)-2, and pediatric sequential organ failure assessment (pSOFA), in critically ill children with sepsis.
 Methods This prospective cohort study was conducted in the pediatric intensive care unit (PICU) and pediatric high care unit (HCU) of dr. Moewardi Hospital, Surakarta, Central of Java. All patients who met the systemic inflammatory response syndrome (SIRS) criteria were included in our study. The exclusion criteria were congenital anomalies of heart or kidney, malignancy, or hematological abnormalities. The data were taken from laboratory and physical examinations by the physicians on duty. The outcome assessed was mortality.
 Results Of 30 subjects, the mean age was 22.22 (SD 29.36) months; the most common infection source was the respiratory tract, followed by gastrointestinal tract and central nervous system. Most subjects were treated in the PICU and had a mean length of stay of 8.70 (SD 11.91) days. Severe sepsis and PELOD-2 were not significant predictors of death. However, pSOFA score was a statistically significant predictor of mortality, with odds ratio 10.11 (95%CI 1.054 to 97.002; P=0.039).
 Conclusion Pediatric SOFA (pSOFA) is a better predictor of mortality compared to PELOD-2 and SIRS-severe sepsis. A pSOFA score ≥ 2 increases the risk of mortality by 10.11-fold.

Pediatric SOFA score for detecting sepsis in children

“…Hence, the most common organ dysfunction in sepsis patients tends to be related to the respiratory system. 9 The ROC curve analysis of pSOFA scores revealed an AUC of 93.9% (95%CI 86.7% to 96.8%), indicating a high level of discrimination for detecting life-threatening organ dysfunction in pediatric sepsis. The consensus for diagnosis and management of child sepsis was set by Indonesian Paediatrics Society (IPS) to be PELOD-2 score ≥ 11, as the cut-off criterion for life-threatening organ dysfunction.…”

“…A study also showed that the most common location of infection was the respiratory system (73.3%). 9 A meta-analysis showed respiratory infections in 61% of children and 41% of infants. 10 Another study also found pneumonia to be the etiology in 40% of cases.…”

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

“…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.…”

Profil Penyakit Kritis di Ruang Rawat Intensif Anak RSUD Dr. Zainoel Abidin Banda Aceh

“…Penyakit primer terbanyak yang memerlukan ventilasi mekanik adalah gangguan respirasi (16,33%), diikuti oleh gangguan neurologi (13,27 %). 13 Pada studi ini penggunaan ventilasi mekanik paling banyak oleh kasus medis (non bedah) 29,7%, dan selanjutnya indikasi pasca bedah 20,3%. Sama seperti penelitian sebelumnya bahwa disfungsi organ respirasi merupakan penyebab utama penggunaan ventilasi mekanik pada pasien dengan penyakit kritis.…”