Validation of PELOD-2 score as a predictor of life-threatening organ dysfunction in pediatric sepsis

Abstract

Background The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction due to immune dysregulation against infection. It recommends the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score to evaluate life-threatening organ dysfunction. But the SOFA tool has not been adjusted for pediatric patients. The Indonesian Pediatrics Society (IPS) uses the same sepsis definition and recommends using the PELOD-2 score as an indicator of life-threatening organ dysfunction in children. 
 Objective To evaluate the validity of the PELOD-2 score for predicting life-threatening organ dysfunction in pediatric sepsis.
 Methods A prospective cohort study was conducted in children with sepsis who were admitted to the PICU. Subjects were taken consecutively with inclusion criteria of 1 month-18 years of age, with organ dysfunction, having two or more symptoms of systemic inflammatory response syndrome (SIRS), and suspected or proven infection. PELOD-2 score, with and without lactate result, of each subject were plotted to receiver operating characteristic (ROC) curve, then we determined the most optimal cut off point to predict the life-threathneing organ dysfunction in pediatric sepsis based on the sensitivity and specificity of each score.
 Results Sixty-six patients were analyzed, with 40 males and 26 females aged 2 to 183 months (median 11 months). Twenty patients died while in the PICU. A PELOD-2 score (with lactate) cut-off ≥ 7 was determined by ROC curve, with sensitivity of 80% and specificity of 78%. The area under the curve (AUC) of PELOD-2 score (with lactate) was 84.8% (95%CI 74.7 to 95.9%). A PELOD-2 score (without lactate) ≥ 7 was the most optimum cut off based on its Youden index, it haD 70% of sensitivity and 80% of specificity.
 Conclusion PELOD-2 score ≥ 7 , with or without lactate component is the optimal cut-off for predicting life-threatening organ dysfunction in pediatric sepsis.

Epidemiology of paediatric severe sepsis and septic shock in Turkey: Prevalence, results and treatments study

“…15 The laboratory results, antimicrobial administration, vasoactive infusions, mechanical ventilation and treatments were collected for 48 h from 9:00 A.M on the day before the study day until 9:00 A.M on the day after the study day. Data for the Paediatric Index of Mortality (PIM)-3 score 16 and Paediatric Logistic Organ Dysfunction score 17 were collected and calculated on the study day. Demographic data for each patient, accompanied conditions (respiratory, cardiac, metabolic, neurological and oncologic diseases), the units in which they were admitted to intensive care (emergency room, medical ward, operating room and other hospitals), the reason for intensive care admission (medical, surgical, trauma), infection site, source of infection (community and hospital), microbiological results, post-diagnosis treatments (vasoactive infusions, antibiotics, antifungal and adjuvant treatments), intensive care stay and mortality were recorded.…”