Performance of Day 1 Paediatric Logistic Organ Dysfunction-2 Score in Children with Severe Sepsis: A Prospective Cohort Study

Abstract

Introduction: Judicious allocation of scarce resources in hospitals of developing countries is important. When a child is admitted to a hospital, it is important to judge the severity of illness and also to predict the mortality risk so that best available resources may be provided. The deranged clinical and laboratory parameters in sick children have been utilised to construct various scores to predict the mortality risk. One such score is Paediatric Logistic Organ Dysfunction-2 (PELOD-2) which is devised to predict mortality risk in children admitted to Paediatric Intensive Care Unit (PICU). The usefulness of PELOD-2 score needs to be tested in developing countries. Aim: To evaluate the performance of PELOD-2 scores in predicting the outcome in severe sepsis patients admitted to PICU of a Tertiary Care Centre. Materials and Methods: This prospective cohort study was done in a tertiary level PICU of a teaching Hospital in the Department of Paediatrics, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India. PELOD-2 scores were calculated on day 1 of admission in PICU to predict the mortality risk patients of age between 1 month to 14 years admitted for severe sepsis. Results: Total 203 cases were enrolled in the study, with mean age of 37 (SD±46.97) months. The observed mortality was 52.21% (106), while PELOD-2 score predicted 57.63% (117) mortality. Mean PELOD-2 score in survivors was 5.95 (±2.47), while in non-survivors it was 12.87 (±4.73). Total 149 (73.4%) cases had 3 or more organ dysfunction. The area under Receiver Operating Characteristic (ROC) curve was 0.89, showing excellent discrimination. Sensitivity and specificity for predicting mortality at PELOD-2 score of 7.5 was 90.56% and 78.35%, respectively. Hosmer-lemeshow goodness for fit test showed good calibration at Chi-square of 2.44 and p-value of 0.11. Conclusion: Day 1 PELOD-2 scores can reliably assess the multiple Organ Dysfunctions (OD) and predict outcomes in severe sepsis patients admitted to PICU in a developing country.