Tripathi Sandeep, McGarvey Jeremy, Montgomery Vicki, Gharpure Varsha P, Kashyap Rahul, Walkey Allan, Bansal Vikas, Boman Karen, Kumar Vishakha K, Kissoon Niranjan
Pediatric Intensive Care, OSF HealthCare, Children's Hospital of Illinois, Peoria, Illinois.
Department of Pediatrics, University of Illinois College of Medicine, Peoria, Illinois.
Hosp Pediatr. 2025 Jul 1;15(7):554-562. doi: 10.1542/hpeds.2024-008161.
A retrospective cohort study on patients aged < 18 years included in the Society of Critical Care Medicine: Viral Infection and Respiratory Illness Universal Study registry from March 2020 to April 2024 with an objective of calculating the prevalence of sepsis as defined by the Phoenix Sepsis Score (PSS) and to validate the PSS with respect to outcomes in children with COVID-19.
Linear mixed-effects regression was used to examine the relationship between the PSS and hospital length of stay after controlling for confounding factors. The performance of the PSS was assessed using the receiver operating characteristic (ROC) and the precision-recall curve (PRC). Cross-validation was performed using leave-one-out cross-validation.
Out of 1731 patients (58 hospitals), 326 (18.8%) met criteria for sepsis and 167 (9.7%) for septic shock. The overall mortality was 1.4% (25/1731), with significant differences between nonseptic (10/1405, 0.7%) and both sepsis (15/326, 4.6%) and septic shock (9/167, 5.4%) groups. After adjusting for confounders, the septic group was associated with a longer hospital length of stay than the nonseptic group. One unit increase in the numeric PSS led to a 70% increase in risk of mortality (odds ratio 1.70; P < .001). The area under the ROC curve was 0.80 and the area under the PRC curve was 0.13. The threshold of ≥ 2 for detection of mortality had a sensitivity of 0.63, specificity of 0.82, and positive predictive value of 0.05.
Phoenix Sepsis Criteria retain its validity in identifying sepsis in children with COVID-19 and can be used in further epidemiological studies in this population.
一项针对年龄小于18岁患者的回顾性队列研究纳入了危重症医学会：2020年3月至2024年4月的病毒感染与呼吸道疾病通用研究登记处的数据，目的是计算由凤凰脓毒症评分（PSS）定义的脓毒症患病率，并验证PSS在新冠病毒感染儿童中的预后情况。
采用线性混合效应回归分析，在控制混杂因素后，研究PSS与住院时间之间的关系。使用受试者工作特征曲线（ROC）和精确召回率曲线（PRC）评估PSS的性能。采用留一法交叉验证进行交叉验证。
在1731例患者（来自58家医院）中，326例（18.8%）符合脓毒症标准，167例（9.7%）符合感染性休克标准。总体死亡率为1.4%（25/1731），非脓毒症组（10/1405，0.7%）与脓毒症组（15/326，4.6%）和感染性休克组（9/167，5.4%）之间存在显著差异。在调整混杂因素后，脓毒症组的住院时间比非脓毒症组更长。PSS数值每增加一个单位，死亡风险增加70%（比值比1.70；P<0.001）。ROC曲线下面积为0.80，PRC曲线下面积为0.13。检测死亡率的阈值≥2时，敏感性为0.63，特异性为0.82，阳性预测值为0.05。
凤凰脓毒症标准在识别新冠病毒感染儿童的脓毒症方面仍然有效，可用于该人群的进一步流行病学研究。
