Christian Kahlert (Switzerland)
Children’s Hospital of Eastern Switzerland PaediatricsAuthor Of 1 Presentation
VALIDATION OF PEDIATRIC ORGAN DYSFUNCTION SCORES IN CHILDREN WITH BLOOD CULTURE-PROVEN INFECTION – A NATIONAL PROSPECTIVE COHORT STUDY
Abstract
Backgrounds:
Previous studies applying Sepsis-3 criteria to pediatric sepsis were based on retrospective analyses of pediatric intensive care unit (PICU) cohorts. We aimed to validate organ dysfunction criteria in a population-based cohort of children with blood culture-proven infection, including emergency department, PICU, and ward patients.
Methods
National multi-center prospective cohort study of children <17 years with blood culture-proven sepsis between 1.9.2011 and 31.12.2015. We excluded preterm infants and neonates ≤7 days. We compared the 2005 International Pediatric Sepsis Consensus Conference (IPSCC), Pediatric Logistic Organ Dysfunction (PELOD)-2, pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Organ Dysfunction Information Update Mandate (PODIUM) scores measured on day of blood culture sampling to predict 30-day mortality using area under the receiver-operating characteristic curves (AUC). Conditional random forest analyses and generalized linear mixed model prediction were used.
Results:
We analyzed 877 sepsis episodes in 807 children, with a 30-day mortality of 4.3%. Presence of any organ dysfunction ranged from 32.7% (2005 IPSCC) to 55.3% (pSOFA). In adjusted analyses, the accuracy to predict mortality was highest for 2005 IPSCC (AUC 0.871, 95%CI: 0.819−0.924), followed by pSOFA (0.852; 95%CI: 0.784−0.92), PODIUM (0.852; 95%CI: 0.791−0.912), and PELOD-2 (0.827; 95%CI: 0.761−0.892). Neurologic, respiratory, and cardiovascular dysfunction were most predictive of 30-day mortality. Considering only these three organs adjusted AUC was 0.784 (0.70 - 0.868) for 2005 IPSCC and 0.771 (0.684-0.857) for PODIUM, while pSOFA (0.734; 0.641-0.828) and PELOD-2 (0.724; 0.627-0.822) had lower performances.
Conclusions/Learning Points:
When comparing scores for organ dysfunction, 2005 IPSCC performed best, followed by pSOFA and PODIUM criteria. Although the accuracy between scores was comparable, we observed major differences in terms of classification of individual organ dysfunctions. Our findings confirm the importance of neurologic, respiratory, and cardiovascular dysfunction.