Performance of the Pediatric Sequential Organ Failure Assessment Score in Assessing the Prognosis of Children with Sepsis in A PICU of A Developing Country: A Single-Center Retrospective Observational Study

Abstract

Background:The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis 3) was based on the sequential organ failure assessment (SOFA) score. Matics and Sanchez-Pinto contrived a SOFA score designed specifically for pediatric patients (pSOFA) to evaluate the prognosis of children with sepsis according to the degree of organ dysfunction. Objectives: The aim of our study was to evaluate the predictive validity of the pSOFA for in-hospital mortality in children with sepsis in a pediatric intensive care unit (PICU) of a developing country. Methods: This was a single-center retrospective observational study. The data of 516 children diagnosed with sepsis according to the 2005 International Pediatric Sepsis Consensus Conference was retrospectively analyzed. The patients were divided into survivor group and non-survivor group according to the clinical outcome of 28 days after admission. The variables of pSOFA score, PELOD-2 score and P-MODS were collected and scored. Receiver operating characteristic (ROC) curve was plotted; the efficiency of the pSOFA score for predicting death was evaluated by the area under ROC curve (AUC). Results: ROC curve analysis showed that the AUCs of the pSOFA score, PELOD-2 score and P-MODS predicting the prognosis of children with sepsis in a PICU of a developing country were 0.937, 0.916, and 0.761, respectively (all P < 0.05). Conclusions:The pSOFA score is effective and has the ability to assess the prognosis of children with sepsis in a PICU of a developing country.

Criteria for Pediatric Sepsis—A Systematic Review and Meta-Analysis by the Pediatric Sepsis Definition Taskforce*

“…Our meta-analysis provides strong support for greater organ dysfunction in nonsurvivors compared with survivors as shown by the pooled estimates for renal dysfunction ( 50 , 64 , 67 , 70 ), multi-organ dysfunction (MODS) ( 23 , 33 , 41 , 50 , 69 , 70 , 93 , 94 ), number of organ dysfunctions ( 28 , 40 , 64 , 83 ), PEdiatric Logistic Organ Dysfunction (PELOD) score ( 23 , 28 , 40 , 44 , 50 , 53 , 55 , 60 , 65 , 72 , 85 ), and PELOD-2 ( 85 , 86 , 95 ). Our meta-analysis also provides strong support for greater illness severity in nonsurvivors compared with survivors as shown by the pooled estimates pediatric Sequential (Sepsis-related) Organ Failure Assessment (pSOFA) ( 50 , 58 , 70 , 95 ) and Sequential (Sepsis-related) Organ Failure Assessment (SOFA) ( 85 , 86 , 95 ), PRISM ( 32 , 43 , 51 , 53 , 55 , 60 – 62 , 64 , 68 , 70 – 72 , 75 , 77 , 81 , 84 , 85 , 88 ), Pediatric Index of Mortality (PIM)-2 ( 79 , 85 ), and PIM-3 ( 23 , 61 , 65 , 85 ) (Supplementary Fig. 7,…”

Accuracy of SIRS, age-adapted pSOFA, and quick SOFA scoring systems for predicting outcomes in paediatric patients with sepsis: a meta-analysis

“…Eleven studies reported information on the predictive capability of age-adapted pSOFA scores, 8e18 six studies reported on SIRS, 1,8,13,17e19 and four studies reported on qSOFA. 13,14,19,20,21 Concerning geographic distribution, five studies were conducted in China, 8,11,12,14,18 two in the UK 19,20 and South Korea, 22,23 one multicentric (Canada, USA and Uganda), 1 and one each was conducted in India, 9 Egypt, 10 Australia, 13 Europe, 15 Iran, 16 and Indonesia 17 (Table 1). The description of scoring system is shown in Supplementary Table 1.…”

Pediatric Sequential Organ Failure Assessment Score: Modifikasi Sistem Skor Pada Sepsis Anak

“…Peneliti membandingkan dengan skor Pediatric Risk of Mortality (PRISM) III sebagai penanda tingkat keparahan penyakit saat datang, dengan menggunakan informasi sejak 24 jam pertama untuk mengevaluasi penggunaan klinis pSOFA pada saat pasien datang. 13 Untuk mengevaluasi lebih lanjut validitas klinis dan utilitas pSOFA dibandingkan dengan sistim penilaian lainnya, skor maksimal dan rata-rata juga dihitung pada 4 waktu yang ditentukan -hari 2, 4, 7, dan 14 setelah masuk PICU. Hanya pasien yang masih hidup dan dirawat di rumah sakit pada hari-hari yang ditentukan digunakan untuk perhitungan.…”

“…Penelitian yang dilakukan oleh Mianling et al 13 tentang hasil Skor pSOFA dalam menilai prognosis anak-anak dengan sepsis di PICU negara berkembang dengan metode studi observasional retrospektif, di salah satu pusat rumah sakit di dapatkan bahwa Skor pSOFA efektif dan memiliki kemampuan untuk menilai prognosis anak-anak dengan sepsis di PICU. Tidak ada perbedaan yang signifikan skor pSOFA dan skor PELOD-2, namun, ada perbedaan yang signifikan antara skor pSOFA dan P-MODS.…”