Comparison of In-hospital Mortality Prognostic Accuracy of the pSOFA Score and SIRS Criteria Among Children With Infection Admitted to Pediatric Intensive Care Units: A Retrospective Multi-center Cohort Study

Abstract

Background: The sepsis version 3.0 highlights the co-existence of infection with organ dysfunction, assessed by the Sequential Organ Failure Assessment (SOFA) score. However, the prognostic accuracy of the Pediatric SOFA score (pSOFA) for in-hospital mortality was not fully validated. We compared the performance of the pSOFA with the SIRS criteria as predictors of in-hospital mortality in children with infectious disease and evaluate whether the pSOFA is suitable to be used in pediatric intensive care units (PICU) in Shandong Province, China.Methods::A retrospective multicenter cohort study was conducted on children hospitalized with confirmed or suspected infection, between January 2011 and December 2019, in three PICUs of three tertiary care hospitals in Shandong Province. The maximum pSOFA score and SIRS criteria within the first 24 hr of PICU admission were calculated. Univariate and multivariate logistic regressions were conducted to analyze the risk factors for in-hospital mortality. Three sub-components of the pSOFA score with relatively good predictive value were identified according to the Yuden Index and formed a simple-pSOFA score. The efficiency and diagnostic ability of these scores were compared by measuring the area under the receiver operating characteristic curve (AUROC) and Delong’s test.Results: 1092 patients were included and the overall in-hospital mortality was 23.4%. Multivariate logistic regressions showed that high 24h pSOFA score, bloodstream as the main infection site, and the need for MV were the risk factors for in-hospital mortality. The AUROC analysis verified that simple-pSOFA had the best diagnostic ability in predicting in-hospital mortality of infected children compared with the 24h pSOFA score and SIRS criteria. The sensitivity and specificity of 24h pSOFA score ≥2 were the highest, 97.6% and 78.9%, respectively.Conclusions: The pSOFA score was superior to SIRS criteria in identifying children with infection and a high risk of mortality, but it is expensive and time-consuming to complete the pSOFA score. Simple-pSOFA score is superior to pSOFA score in early identification of infected children with a high risk of death, but further validation studies with a larger size is needed.