Predicting mortality in pediatric sepsis: A real-world data analysis using a pediatric sepsis surveillance method

Abstract

Abstract Purpose Sepsis surveillance methods using electronic medical records based on the latest definition of sepsis are increasingly used to describe the real-world epidemiology of adult sepsis. However, its application in pediatric populations has been limited, and pediatric sepsis outside pediatric intensive care units has not been well studied. We aimed to determine whether this surveillance method could identify children with sepsis at high-risk of mortality and to evaluate the criteria for organ dysfunction within the method. Methods From an inpatient database including ≥ 200 acute-care hospitals in Japan, we included children of ≤ 21 years of age who were admitted to hospitals between 2014 and 2021, underwent blood culture tests, and received antimicrobial treatment for ≥ 4 days. We stratified these children into children with sepsis or without sepsis by the presence of organ dysfunction. We evaluated the discrimination for in-hospital mortality by the sepsis diagnosis, the number of organ dysfunction and modified criteria for sepsis diagnosis. Results Among 6553 eligible children, the in-hospital mortality was 7.2% in 875 children with sepsis and 0.2% in 5678 children without sepsis. Sepsis diagnosis discriminated in-hospital mortality with a sensitivity of 0.84 and a specificity of 0.87. In-hospital mortality incrementally increased with the number of organ dysfunction; zero, 0.2%; one, 3.4%; two, 12.7%; three, 20.9%; four, 33.3%; and five, 50.0%. The area under the curve (AUC) for mortality based on the number of organ dysfunction was 0.88 (95% confidence interval: 0.84–0.93). The sensitivity and AUC value slightly improved after modifying the criterion for hepatic dysfunction. Conclusions The surveillance method effectively identified children with sepsis with high-risk of mortality and demonstrated strong discrimination of mortality. Further refinement of the method may be possible by adjusting the criteria.