Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
Eur J Pediatr. 2024 Nov;183(11):5033-5035. doi: 10.1007/s00431-024-05767-1. Epub 2024 Sep 11.
Sepsis is the leading cause of mortality in children worldwide. There is a paucity of data on the criteria used to define sepsis and septic shock and predict mortality. Schlapbach et al. published Phoenix criteria to define sepsis in JAMA in 2024. Previously, paediatricians have used systemic inflammatory response syndrome (SIRS) criteria, but these criteria lack sensitivity and specificity. This group recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Though included in the 8-point criteria, important criteria like renal and liver are missing from the main criteria. We remain worried about the way these criteria got excluded from the main criteria. Therefore, in this brief report, whilst commending the authors for this stelar task, we highlight the main pitfalls in these criteria especially the renal, neurologic, and liver criteria. These criteria have been shown to be independently associated with outcomes, and we recommend that in the future iterations of the criteria, renal and liver criteria should be defined according to latest definitions and the task force consider utilizing latest criteria for each organ system involved within the formulated criteria.
In conclusion, Phoenix criteria are a step in the right direction to define life-threatening organ dysfunction in sepsis, but clinicians need to be mindful that diagnosis/treatment of less severe sepsis should not be delayed if these criteria are not met. Therefore, local early detection and management tools for sepsis should be followed.
• There has always been a quest for a definition for pediatric sepsis. There are limitations to the previous pediatric sepsis criteria which were published in 2005 by the International Pediatric Sepsis Consensus Conference (IPSCC). IPSCC defines sepsis as a suspected or confirmed infection in the presence of systemic inflammatory response syndrome (SIRS). These new Phoenix Pediatric Sepsis (PPS) criteria for sepsis and septic shock are intended to identify children with life-threatening organ dysfunction due to infection, and the score was developed based on a very large pediatric dataset.
• Though the intention of Phoenix criteria is to help identify children with life threatening organ dysfunction, unfortunately the crietria will miss signs of early sepis. In this manuscript, we point out some of the drawbacks of these criteria which need to be borne in mind while applying these criteria.
脓毒症是全球儿童死亡的主要原因。目前关于定义脓毒症和感染性休克的标准以及预测死亡率的数据很少。Schlapbach 等人在 2024 年的《美国医学会杂志》上发表了凤凰标准来定义脓毒症。在此之前，儿科医生一直使用全身炎症反应综合征（SIRS）标准，但这些标准缺乏敏感性和特异性。该研究小组建议，对于疑似感染的儿童，用 Phoenix 败血症评分至少 2 分来识别败血症，这表明呼吸、心血管、凝血和/或神经系统可能出现危及生命的功能障碍。尽管该评分标准包含在 8 分标准中，但主要标准中缺少重要标准，如肾脏和肝脏。我们仍然担心这些标准从主要标准中被排除的方式。因此，在本简要报告中，我们在赞扬作者完成这项重要任务的同时，强调了这些标准的主要缺陷，特别是肾脏、神经和肝脏标准。这些标准已被证明与结果独立相关，我们建议在未来的标准迭代中，应根据最新定义定义肾脏和肝脏标准，并考虑在制定的标准中使用最新的每个涉及器官系统的标准。
总之，凤凰标准是朝着定义脓毒症危及生命的器官功能障碍迈出的正确一步，但临床医生需要注意，如果不符合这些标准，不应延迟诊断/治疗较轻的脓毒症。因此，应遵循针对脓毒症的当地早期检测和管理工具。
一直以来，人们都在寻求儿科脓毒症的定义。之前的儿科脓毒症标准（2005 年由国际儿科脓毒症共识会议[IPSCC]发布）存在局限性。IPSCC 将脓毒症定义为疑似或确诊感染时存在全身炎症反应综合征（SIRS）。这些新的凤凰儿科脓毒症（PPS）脓毒症和感染性休克标准旨在识别因感染导致危及生命的器官功能障碍的儿童，该评分是基于一个非常大的儿科数据集开发的。
虽然凤凰标准的目的是帮助识别有生命威胁的器官功能障碍的儿童，但不幸的是，这些标准将错过早期脓毒症的迹象。在本文中，我们指出了在应用这些标准时需要注意的一些缺点。
