Performance of prognostic markers in pediatric sepsis

Predicting mortality in pediatric sepsis: A laudable but elusive goal

“…Overall, the researchers found that the PIM2 score had the best discriminatory power for mortality (area under the curve [AUC] 0.815; 95% CI 0.766–0.858), better than any single biomarker (ferritin AUC 0.785, 95% CI 0.733–0.830; lactate AUC 0.762, 95% CI 0.709–0.810; and CRP AUC 0.648, 95% CI 0.590–0.702). 4 Leukocyte count stood out as the sole biomarker with poor discriminatory power; it was as good at predicting mortality as a coin toss (AUC 0.508; 95% CI 0.450–0.567). 4 It is not surprising that leukocyte count was uninformative when discriminating between septic patients given that SIRS criteria, which includes a criterion for abnormal leukocyte count, was used to diagnose sepsis.…”

“… 4 Leukocyte count stood out as the sole biomarker with poor discriminatory power; it was as good at predicting mortality as a coin toss (AUC 0.508; 95% CI 0.450–0.567). 4 It is not surprising that leukocyte count was uninformative when discriminating between septic patients given that SIRS criteria, which includes a criterion for abnormal leukocyte count, was used to diagnose sepsis. 6 …”

“…In this issue of the Jornal de Pediatria, Tonial et al take the approach of predicting pediatric sepsis prognosis using a panel of biomarkers and an existing pediatric mortality prediction score, the Pediatric Index of Mortality 2 (PIM2). 4 PIM2 is a composite score representing patient risk factors, patient comorbidities, key laboratory data, and vital sign measurements. Tonial et al sought to test the prognostic performance of each of the following alone and in combination: biomarkers reflecting the host response (CRP, ferritin, and leukocyte count), a marker of perfusion deficit (lactate) and the PIM2 score.…”

“…Tonial et al sought to test the prognostic performance of each of the following alone and in combination: biomarkers reflecting the host response (CRP, ferritin, and leukocyte count), a marker of perfusion deficit (lactate) and the PIM2 score. 4 , 5 The researchers retrospectively studied children aged 6 months to 18 years admitted to the pediatric intensive care unit (PICU) of a tertiary care center in Brazil with a diagnosis of sepsis defined by systemic inflammatory response syndrome (SIRS) criteria and in whom all biomarkers were measured (N = 294 of 350 admissions). 4 , 6 For prognostication, the authors used the highest ferritin and CRP levels within 48 h and the highest lactate level and leukocyte count within 24 h of PICU admission.…”

“… 4 , 6 For prognostication, the authors used the highest ferritin and CRP levels within 48 h and the highest lactate level and leukocyte count within 24 h of PICU admission. 4 …”