RESUMO OBJETIVO: Avaliar o desempenho dos escores de mortalidade Pediatric Risk of Mortality (PRISM) e Pediatric Index of Mortality 2 (PIM2) na Unidade de Terapia Intensiva Pediátrica (UTIP) Terciária da Fundação Santa Casa de Misericórdia do Pará (FSCMPA). MATERIAIS E MÉTODOS: Estudo de coorte retrospectivo, incluindo pacientes admitidos na UTIP, entre janeiro de 2017 a abril de 2018, com permanência por mais de 8 h. Os critérios de exclusão foram: permanência superior a 90 dias; parada cardiorrespiratória sem estabilidade em 12 h; cuidados paliativos; e morte encefálica. Para calcular os sistemas de escores e desfecho, utilizou-se as variáveis Standardized Mortality Rate (SMR), calibração e discriminação, que foram comparadas pelos testes goodness-of-fit e curvas Receiver Operating Characteristic (ROC), respectivamente. RESULTADOS: Entre as 458 internações, 429 (93,7%) foram incluídas. A mortalidade geral foi de 17,5%, sendo que 64,0% eram menores de 2 anos de idade e 58,7% dos que evoluíram a óbito foram submetidos à ventilação mecânica por período maior que sete dias. A média de probabilidade de morte estimada do PRISM foi 9,85%, enquanto a média do PIM2 foi de 14,2%. O SMR foi de 1,35 (1,26-1,72) para o PRISM e de 1,23 (1,13-1,58) para o PIM2. A área sob a curva ROC foi de 0,89 (IC 95% 0,81-0,91) para o PRISM e 0,87 (IC 95% 0,83-0,91) para o PIM2. CONCLUSÃO: Na UTIP da FSCMPA, o PRISM e o PIM2 tiveram boa calibração e bom poder discriminatório. O SMR foi superior a um.ABSTRACT OBJECTIVE: To evaluate the performance of the Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality 2 (PIM2) scores in the Tertiary Pediatric Intensive Care Unit (PICU) of the Fundação Santa Casa de Misericórdia do Pará (FSCMPA). MATERIALS AND METHODS: A retrospective cohort study was conducted with patients hospitalized in PICU for more than 8 h, from January 2017 to April 2018. Exclusion criteria were: stay longer than 90 days; cardiorespiratory arrest without stability in 12 h; palliative care; and brain death. To calculate score and outcome systems, Standardized Mortality Rate (SMR), calibration, and discrimination variables were used and compared by goodness-of-fit and Receiver Operating Characteristic (ROC) curves, respectively. RESULTS: Among the 458 hospitalizations, 429 (93.7%) were included. Overall mortality was 17.5%, with 64.0% under 2 years of age; and 58.7% of those who evolved to death were submitted to mechanical ventilation for more than seven days. The estimated mean probability of death from PRISM was 9.85%, while the mean PIM2 was 14.2%. The SMR was 1.35 (1.26-1.72) for PRISM and 1.23 (1.13-1.58) for PIM2. The area under the ROC curve was 0.89 (95% CI 0.81-0.91) for PRISM and 0.87 (95% CI 0.83-0.91) for PIM2. CONCLUSION: In the FSCMPA PICU, PRISM and PIM2 had good calibration and good discriminatory power. The SMR was greater than one.

Background: Some children can develop severe forms of SARS-CoV-2 infection either acutely or later, as represented by multisystemic inflammatory syndrome in children (MIS- C). To identify the risk factors for worse outcomes in hospitalized children and adolescents with severe acute SARS-CoV-2 infection and MIS-C. Methods: This multicenter cohort study included all children and adolescents with confirmed or suspected critical SARS-CoV-2 infection admitted to the PICU between April 2020 and September 2021. The exclusion criteria were incomplete vaccinal status, immunocompromised status, and end-of-life decision. The main variables analyzed were epidemiological, clinical, and laboratory data, and ventilator settings at admission and after 72 h. The patients were divided into three groups (G): confirmed coronavirus disease (COVID-19) with MIS-C criteria (G1), confirmed COVID-19 without MIS-C criteria (G2), and MIS-C criteria without confirmed COVID-19. Results: The median age of the patients was 28 months in G1, with comorbidities in 40 patients (72.7%) (p < 0.0001). The duration of exposure (median 23 days; p = 0.004) and fever were longer in G1 (12 days; p = 0.001). Moreover, invasive mechanical ventilation (IMV) was required in 44 patients (80%, p < 0.0001), and cardiogenic shock occurred in 26 patients (54.2%, p < 0.0001) in G1. Subnutrition was most frequent in G1 in 55 cases (57.3%; p = 0.01). Under nutrition (< 2 SD for weight), longer exposure time (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.37–3.25; p = 0.001), IMV time (OR: 2.6; 95% CI: 1.15–5.85; p = 0.03), and length of hospital stay (OR: 10.94; 95% CI: 1.93–63.1; p = 0.007) were associated with critical MIS-C in G1. Conclusions: In the Brazilian Amazon area, specifically in the Pará state, we identified a cluster of more severe forms of pediatric acute or late SARS-CoV-2 infection.

Objectives: To determine blood glucose distribution values; to assess the association of admission serum glucose levels with 28-day mortality to the frequency of invasive mechanical ventilation-free days. Design: Retrospective cohort studySetting: Brazilian Amazon Region. Patients: Population (n = 400) composed of patients admitted to the pediatric intensive care unit, from January 2016 to December 2017. Exclusion criteria were patients with length of stay of <24 hours; diabetes mellitus; suspicion or evidence of inborn errors of metabolism; insulin use; palliative care and brain death. Main outcome measures: The patients were divided into 4 groups: 1) serum glucose <60mg/dL; 2) control group if serum glucose between 60-126 mg/dL; 3) between 127-150mg/dL; or 4) if > 150mg/dL. Results: Serum glucose levels frequency were: <60: 43 (11%); 60-126: 235 (58.7%); 127-150: 51 (13%) and > 150: 71 (18%). Groups 3 and 4 had the highest frequency of external origin, with respectively 24 (47.1%) and 40 (56.3%); the main diagnosis was infection, with 26 (51%) and 50 (70.4%), respectively. Sepsis occurred in 24 (47.1%) and 47 (66.2%) individuals in the groups 3 and 4, respectively, while septic shock was more frequent in the group 4 (46 [4.8%]). Group 2 had predominance of ventilator-associated pneumonia with 11 (36.7%). The estimate of ventilation-free days in group 4 was 2.84 (SD +/- 0.69; 95% CI: 1.5-4.2). Conclusion: Hyperglycemia group had a lower frequency of ventilation-free days and higher 28-day mortality.