Comparing the precision of the pSOFA and SIRS scores in predicting sepsis-related deaths among hospitalized children: a multi-center retrospective cohort study

Abstract

BACKGROUND:The latest sepsis definition includes both infection and organ failure, as evidenced by the sequential organ failure assessment (SOFA) score. However, the applicability of the pediatric SOFA score (pSOFA) is not yet determined. This study evaluated the effectiveness of both pSOFA and system inflammatory reaction syndrome (SIRS) scores in predicting sepsis-related pediatric deaths.METHODS: This is a retrospective multi-center cohort study including hospitalized patients <18 years old with diagnosed or not-yet-diagnosed infections. Multivariate analyses were carried out to evaluate risk factors for in-hospital mortality. According to Youden index (YI), three sub-categories of pSOFA were screened out and a new simplified pSOFA score (spSOFA) was formed. The effectiveness and accuracy of prediction of pSOFA, SIRS and spSOFA was retrieved from the area under the receiver operating characteristic curve (AUROC) and Delong's test.RESULTS: A total of 1,092 participants were eligible for this study, and carried a 23.4% inhospital mortality rate. The 24-h elevated pSOFA score (24 h-pSOFA), bloodstream infection, and mechanical ventilation (MV) requirement were major risk factors associated with sepsis-related deaths. The AUROC analysis confirmed that the spSOFA provided good predictive capability in sepsis-related pediatric deaths, relative to the 24 h-pSOFA and SIRS.CONCLUSIONS: The pSOFA score performed better than SIRS in diagnosing infected children with high mortality risk. However, it is both costly and cumbersome. We, therefore, proposed spSOFA to accurately predict patient outcome, without the disadvantages. Nevertheless, additional investigations, involving a large sample population, are warranted to confirm the conclusion of this study.

Epidemiology and Clinical Characteristics of Pediatric Sepsis in PICUs in Southwest China: A Prospective Multicenter Study*

“…A multicenter binational cohort study of PICUs in Australia and New Zealand was conducted by Schlapbach et al (10), and compared the predictive efficacy of SIRS, age-adapted SOFA, rapid SOFA, and PEdiatric Logistic Organ Dysfunction-2 scores for outcomes in children with sepsis, and the results suggested that the SIRS criteria lacked specificity and failed to identify infected children at higher risk of death. Other researchers have reached the same conclusion (29, 30). It is well known that sepsis in children has a rapid progression and high early mortality.…”

The clinical Spectrum of Viridans Group Streptococci infections in paediatric patients at a tertiary hospital

“…The sepsis scores could not be calculated for some patients because it requires tests which were not performed or documented; this is a limitation of its use in clinical practice especially in developing countries. 35 The same study found pSOFA to be a better predictor of death than SIRS score. 35 In our cohort, the pSOFA and SIRS score yielded different results in patients in which it could be calculated; the SIRS score suggested sepsis in most of the patients, but the pSOFA score was not suggestive of sepsis.…”

“… 35 The same study found pSOFA to be a better predictor of death than SIRS score. 35 In our cohort, the pSOFA and SIRS score yielded different results in patients in which it could be calculated; the SIRS score suggested sepsis in most of the patients, but the pSOFA score was not suggestive of sepsis. The invasiveness of the organism as shown by the CSF results also supports true infection.…”

Early diagnosis and management of neonatal sepsis: a perspective

“…Various predictive models and scoring systems for neonatal sepsis have been developed and applied in diagnostic settings and retrospective studies. [7][8][9]. The clinical perinatal risk assessment program and the development guidelines for EOS, such as the National Institute for Health and Care Excellence (NICE) sepsis guideline [10], and Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) guidelines for EOS risk assessment [11], play crucial roles in this regard.…”