Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
The University of Utah, Salt Lake City, UT.
Pediatr Crit Care Med. 2021 Jan 1;22(1):8-15. doi: 10.1097/PCC.0000000000002572.
The Life After Pediatric Sepsis Evaluation investigation recently reported that one-third of children who survive sepsis experience significant health-related quality-of-life impairment compared with baseline at 1 year after hospitalization. Pediatric Sepsis Biomarker Risk Model is a multibiomarker tool for estimating baseline risk of mortality among children with septic shock. We determined if the Pediatric Sepsis Biomarker Risk Model biomarkers have predictive capacity for estimating the risk of hospital mortality and long-term health-related quality-of-life morbidity among children with community-acquired septic shock.
Secondary analysis.
Twelve academic PICUs.
A subset of Life After Pediatric Sepsis Evaluation subjects (n = 173) with available blood samples.
None.
Three predefined outcomes from the Life After Pediatric Sepsis Evaluation investigation were evaluated: all-cause hospital mortality (n = 173), and the composite outcome of mortality or persistent, serious deterioration of health-related quality of life (> 25% below baseline) among surviving children at 1 month (n = 125) or 3 months (n = 117). Pediatric Sepsis Biomarker Risk Model had an area under the receiver operating characteristic curve of 0.73 (95% CI, 0.59-0.87; p = 0.002) for estimating the risk of hospital mortality and was independently associated with increased odds of hospital mortality. In multivariable analyses, Pediatric Sepsis Biomarker Risk Model was not independently associated with increased odds of the composite outcome of mortality or deterioration of persistent, serious deterioration health-related quality of life greater than 25% below baseline. A new decision tree using the Pediatric Sepsis Biomarker Risk Model biomarkers had an area under the receiver operating characteristic curve of 0.87 (95% CI, 0.80-0.95) for estimating the risk of persistent, serious deterioration health-related quality of life at 3 months among children who survived septic shock.
Pediatric Sepsis Biomarker Risk Model had modest performance for estimating hospital mortality in an external cohort of children with community-acquired septic shock. The Pediatric Sepsis Biomarker Risk Model biomarkers appear to have utility for estimating the risk of persistent, serious deterioration of health-related quality of life up to 3 months after surviving septic shock. These findings suggest an opportunity to develop a clinical tool for early assignment of risk for long-term health-related quality-of-life morbidity among children who survive septic shock.
儿科脓毒症后评估研究最近报告称，与住院后 1 年的基线相比，三分之一幸存脓毒症的儿童在健康相关生活质量方面存在显著受损。儿科脓毒症生物标志物风险模型是一种用于估计脓毒性休克儿童死亡基线风险的多生物标志物工具。我们确定儿科脓毒症生物标志物风险模型的生物标志物是否具有预测能力，以估计社区获得性脓毒性休克儿童的住院死亡率和长期健康相关生活质量发病率的风险。
二次分析。
12 个学术 PICUs。
儿科脓毒症后评估研究的亚组（n = 173）有可用的血液样本。
无。
从儿科脓毒症后评估研究中评估了三个预设结果：全因住院死亡率（n = 173），以及存活儿童在 1 个月（n = 125）或 3 个月（n = 117）时死亡率或持续存在的严重健康相关生活质量恶化（低于基线 25%以上）的复合结局。儿科脓毒症生物标志物风险模型对预测住院死亡率的受试者工作特征曲线下面积为 0.73（95%置信区间，0.59-0.87；p = 0.002），并与住院死亡率的几率增加独立相关。在多变量分析中，儿科脓毒症生物标志物风险模型与死亡率或持续存在的严重恶化健康相关生活质量恶化的复合结局的几率增加无关。使用儿科脓毒症生物标志物风险模型生物标志物的新决策树对存活脓毒性休克儿童 3 个月时持续存在的严重恶化健康相关生活质量的风险进行预测，其受试者工作特征曲线下面积为 0.87（95%置信区间，0.80-0.95）。
儿科脓毒症生物标志物风险模型在社区获得性脓毒性休克儿童的外部队列中对预测住院死亡率具有中等表现。儿科脓毒症生物标志物风险模型生物标志物似乎可用于估计存活脓毒性休克后 3 个月内健康相关生活质量持续严重恶化的风险。这些发现表明有机会为存活脓毒性休克的儿童开发一种用于早期分配长期健康相关生活质量发病率风险的临床工具。
