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

doi:10.5847/wjem.j.1920-8642.2022.060

Abstract

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% in-hospital 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.

Key words: Simple-pSOFA, pSOFA, Children, Mortality, Infection, SIRS

Chun Zhao, Mei-yun Xin, Jing Li, Jin-fang Zhao, Yu-juan Wang, Wei Wang, Qian Gao, Jie Chen, Qi-wei Wang, You-peng Jin. Comparing the precision of the pSOFA and SIRS scores in predicting sepsis-related deaths among hospitalized children: a multi-center retrospective cohort study[J]. World Journal of Emergency Medicine, 2022, 13(4): 259-265.

Figures/Tables 7

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Characteristics	All (n=1,092)	Survivors (n=837)	Non-survivors (n=255)	P-value
Age, months	7.0 (2.9-19.2)	7.0 (2.9-19.0)	6.0 (2.8-24.0)	0.100
Male	669 (61.3)	156 (61.2)	513 (61.3)	1.000
Type of admission				0.450
Medical condition	953 (87.2)	734 (87.7)	219 (85.9)
Surgical condition	139 (12.8)	103 (12.3)	36 (14.1)	-
Admission type
Respiratory failure	403 (36.9)	339 (40.5)	64 (25.1)	<0.001
Neurologic compromise	175 (16.0)	147 (17.6)	28 (11.0)	0.010
Cardiovascular compromise	168 (15.4)	92 (11.0)	76 (29.8)	<0.001
Hematologic derangement	113 (10.3)	86 (10.3)	27 (10.6)	0.890
Metabolic derangement	88 (8.1)	78 (9.3)	10 (3.9)	0.010
Trauma	107 (9.8)	75 (9.0)	32 (12.5)	0.090
Other	38 (3.5)	20 (2.4)	18 (7.1)	<0.001
Infection source
Bloodstream	147 (13.5)	102 (12.2)	45 (17.6)	0.030
Respiratory tract	625 (57.2)	502 (60.0)	123 (48.2)	0.001
Cerebral	132 (12.1)	108 (12.9)	24 (9.4)	0.130
Genitourinary tract	9 (0.8)	9 (1.1)	0 (0)	0.100
Digestive tract	117 (10.7)	75 (9.0)	42 (16.5)	0.001
Other	62 (5.7)	41 (4.9)	21 (8.2)	0.044
SIRS criteria score (n=1,092)	2 (1-3)	2 (1-3)	2 (1-3)	0.018
24 h-pSOFA (n=898)	4.0 (2.0-6.0)	3.0 (2.0-5.0)	6.0 (4.0-9.0)	<0.001
Treatments
Mechanical ventilation	825 (75.5)	585 (69.9)	240 (94.1)	<0.001
Continuous blood purification	144 (13.2)	93 (11.1)	51 (20.0)	<0.001
Outcomes
Ventilator days, d	2.7 (0-7.7)	4 (0-9)	6 (1-12)	<0.001
PICU LOS, d	8 (4-15)	14 (8-24)	10 (3-16)	<0.001

Variables	B	S.E.	Wald	P-value	OR (95% CI)
Infection source	-0.301	0.055	55.701	<0.001
Respiratory tract	-0.561	0.785	0.510	0.475	0.571 (0.123-2.660)
Bloodstream	-2.853	0.979	8.500	0.004	0.058 (0.008-0.393)
Hepatobiliary system	-0.970	1.012	0.918	0.338	0.379 (0.052-2.757)
SIRS	-0.149	0.099	2.284	0.131	0.861 (0.709-1.045)
24 h-pSOFA	0.241	0.030	64.029	<0.001	1.273 (1.200-1.350)
MV	1.732	0.331	27.329	<0.001	5.653 (2.953-10.822)
CBP	-0.176	0.245	0.581	0.472	0.839 (0.519-1.354)

Predictor	AUC	95% CI	S.E.		P-value
SIRS	0.559	0.519-0.600	0.021		0.004
24 h-pSOFA	0.740	0.706-0.774	0.017		<0.001
Simple-pSOFA	0.751	0.716-0.786	0.019		<0.001
Predictor	Definition	In-hospital mortality
Predictor	Definition	Sensitivity (%)	Specificity (%)	Negative predictive value (%)	Positive predictive value (%)
SIRS	≥ 2 criteria (pediatric)	74.1	32.6	80.5	25.1
	≥ 3 criteria (pediatric)	45.9	65.2	76.3	22.8
24 h-pSOFA	≥ 2	97.6	21.1	95.5	27.6
	≥ 4	79.2	52.7	89.1	33.4
	≥ 5	68.2	69.2	87.4	39.5
Simple-pSOFA	≥ 2	83.5	48.7	90.7	33.2
	≥ 3	65.9	74.6	87.8	44.1

Variables	Score^a
Variables	0	1	2		3	4
Coagulation^b
Platelet count,×10⁹ /L	≥150	100-149	50-99		20-49	<20
Cardiovascular
MAP (mmHg) by age group				Vasoactive infusion (μg/[kg·min])^c
<1 month	≥46	<46	Dopamine hydrochloride ≤5 or dobutamine hydrochloride (any)		Dopamine hydrochloride >5 or epinephrine ≤0.1 or norepinephrine bitartrate ≤0.1	Dopamine hydrochloride >15 or epinephrine >0.1 or norepinephrine bitartrate >0.1
1-11 months	≥55	<55
12-23 months	≥60	<60
24-59 months	≥62	<62
60-143 months	≥65	<65
144-216 months	≥67	<67
>216 months	≥70	<70
Neurologic
Glasgow Coma Score^d	15	13-14	10-12		6-9	<6

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