Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study-Reference-Cited by-同舟云学术

Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study

Published:2023-10-25 Issue: Volume: Page:
ISSN:1529-7535
Container-title:Pediatric Critical Care Medicine
language:en
Short-container-title:

Author:

Schlapbach Luregn J.¹²,Goertz Sabrina³,Hagenbuch Niels⁴,Aubert Blandine⁵,Papis Sebastien⁶,Giannoni Eric⁵,Posfay-Barbe Klara M.⁶,Stocker Martin⁷,Heininger Ulrich⁸,Bernhard-Stirnemann Sara⁹,Niederer-Loher Anita¹⁰,Kahlert Christian R.¹⁰,Natalucci Giancarlo¹¹,Relly Christa³,Riedel Thomas⁴¹²,Aebi Christoph⁴,Berger Christoph³,Agyeman Philipp K. A.⁴,

Affiliation:

1. Department of Intensive Care and Neonatology, and Children`s Research Center, University Children`s Hospital Zurich, Zurich, Switzerland.

2. Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia.

3. Division of Infectious Diseases, and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland.

4. Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

5. Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

6. Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, Children’s Hospital of Geneva, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.

7. Children’s Hospital Lucerne, Lucerne, Switzerland.

8. Infectious Diseases and Vaccinology, University Children’s Hospital Basel, Basel, Switzerland.

9. Children’s Hospital Aarau, Aarau, Switzerland.

10. Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland.

11. Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.

12. Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland.

Abstract

Objectives: Previous studies applying Sepsis-3 criteria to children were based on retrospective analyses of PICU cohorts. We aimed to compare organ dysfunction criteria in children with blood culture-proven sepsis, including emergency department, PICU, and ward patients, and to assess relevance of organ dysfunctions for mortality prediction. Design: We have carried out a nonprespecified, secondary analysis of a prospective dataset collected from September 2011 to December 2015. Setting: Emergency departments, wards, and PICUs in 10 tertiary children’s hospitals in Switzerland. Patients: Children younger than 17 years old with blood culture-proven sepsis. We excluded preterm infants and term infants younger than 7 days old. Interventions: None. Measurements and Main Results: We compared the 2005 International Pediatric Sepsis Consensus Conference (IPSCC), Pediatric Logistic Organ Dysfunction-2 (PELOD-2), pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Organ Dysfunction Information Update Mandate (PODIUM) scores, measured at blood culture sampling, to predict 30-day mortality. We analyzed 877 sepsis episodes in 807 children, with a 30-day mortality of 4.3%. Percentage with organ dysfunction ranged from 32.7% (IPSCC) to 55.3% (pSOFA). In adjusted analyses, the accuracy for identification of 30-day mortality was area under the curve (AUC) 0.87 (95% CI, 0.82–0.92) for IPSCC, 0.83 (0.76–0.89) for PELOD-2, 0.85 (0.78–0.92) for pSOFA, and 0.85 (0.78–0.91) for PODIUM. When restricting scores to neurologic, respiratory, and cardiovascular dysfunction, the adjusted AUC was 0.89 (0.84–0.94) for IPSCC, 0.85 (0.79–0.91) for PELOD-2, 0.87 (0.81–0.93) for pSOFA, and 0.88 (0.83–0.93) for PODIUM. Conclusions: IPSCC, PELOD-2, pSOFA, and PODIUM performed similarly to predict 30-day mortality. Simplified scores restricted to neurologic, respiratory, and cardiovascular dysfunction yielded comparable performance.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

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