Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy.
Pediatric Emergency Department, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
Pediatr Emerg Care. 2023 Jun 1;39(6):378-384. doi: 10.1097/PEC.0000000000002938.
To compare the performance of several prognostic scores calculated in the first 24 hours of admission (day 1) in predicting mortality and morbidity among critically ill children with sepsis presenting to the pediatric emergency department (PED) and then admitted to the pediatric intensive care unit (PICU).
Single-center, retrospective cohort study in children with a diagnosis of sepsis visiting the PED and then admitted to the PICU from January 1, 2010 to December 31, 2019. Sepsis organ dysfunction scores-pediatric Sequential Organ Failure Assessment (pSOFA) (Schlapbach, Matics, Shime), quickSOFA, quickSOFA-L, Pediatric Logistic Organ Dysfunction (PELOD)-2, quickPELOD-2, and Pediatric Multiple Organ Dysfunction score-were calculated during the first 24 hours of admission (day 1) and their performance compared with systemic inflammatory response syndrome (SIRS) and severe sepsis-International Consensus Conference on Pediatric Sepsis(ICCPS)-derived criteria-using the area under the receiver operating characteristic curve. Primary outcome was PICU mortality. Secondary outcomes were: a composite of death and new disability (ie, change from baseline Pediatric Overall Performance Category score ≥1); prolonged PICU length of stay (>5 d); prolonged invasive mechanical ventilation (MV) (>3 d).
Among 60 patients with sepsis, 4 (6.7%) died, 7 (11.7%) developed new disability, 26 (43.3%) experienced prolonged length of stay, and 21 (35%) prolonged invasive MV. The prognostic ability in mortality discrimination was significantly higher for organ dysfunction scores, with PELOD-2 showing the best performance (area under the receiver operating characteristic curve, 0.924; 95% confidence interval, 0.837-1.000), significantly better than SIRS 3 criteria (0.924 vs 0.509, P = 0.009), SIRS 4 criteria (0.924 vs 0.509, P < 0.001), and severe sepsis (0.924 vs 0.527, P < 0.001). Among secondary outcomes, PELOD-2 performed significantly better than SIRS criteria and severe sepsis to predict prolonged duration of invasive MV, whereas better than severe sepsis to predict "poor outcome" (mortality or new disability).
Day 1 organ dysfunction scores performed better in predicting mortality and morbidity outcomes than ICCPS-derived criteria. The PELOD-2 was the organ dysfunction score with the best performance for all outcomes.
比较入住重症监护病房（PICU）前 24 小时（第 1 天）计算的几种预后评分在预测儿科急诊就诊的脓毒症危重病患儿死亡率和发病率方面的表现，然后再收入儿科重症监护病房（PICU）。
这是一项单中心、回顾性队列研究，研究对象为 2010 年 1 月 1 日至 2019 年 12 月 31 日期间在儿科急诊就诊后入住 PICU 的脓毒症患儿。入住第 1 天（第 1 天）计算了脓毒症器官功能障碍评分-小儿序贯器官衰竭评估（pSOFA）（Schlapbach、Matics、Shime）、快速 SOFA、快速 SOFA-L、小儿逻辑器官功能障碍（PELOD）-2、快速 PELOD-2 和小儿多器官功能障碍评分，并使用受试者工作特征曲线下面积比较全身炎症反应综合征（SIRS）和严重脓毒症-小儿脓毒症国际共识会议（ICCPS）衍生标准的表现。主要结局是 PICU 死亡率。次要结局是：死亡和新残疾的复合指标（即，从基线儿科总体表现类别评分≥1 变化）；PICU 住院时间延长（>5 天）；延长有创机械通气（MV）（>3 天）。
在 60 例脓毒症患儿中，4 例（6.7%）死亡，7 例（11.7%）发生新残疾，26 例（43.3%）经历 PICU 住院时间延长，21 例（35%）延长有创 MV。器官功能障碍评分在死亡率判别中的预后能力明显更高，PELOD-2 表现最佳（受试者工作特征曲线下面积，0.924；95%置信区间，0.837-1.000），明显优于 SIRS 3 标准（0.924 与 0.509，P = 0.009）、SIRS 4 标准（0.924 与 0.509，P < 0.001）和严重脓毒症（0.924 与 0.527，P < 0.001）。在次要结局中，PELOD-2 在预测有创 MV 持续时间方面优于 SIRS 标准和严重脓毒症，而在预测“不良结局”（死亡或新残疾）方面优于严重脓毒症。
第 1 天的器官功能障碍评分在预测死亡率和发病率方面的表现优于 ICCPS 衍生标准。PELOD-2 在所有结局方面都是表现最佳的器官功能障碍评分。
