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

• Published in: World journal of emergency medicine Vol. 13; no. 4; pp. 259 - 265
• Main Authors: Zhao, Chun, Xin, Mei-Yun, Li, Jing, Zhao, Jin-Fang, Wang, Yu-Juan, Wang, Wei, Gao, Qian, Chen, Jie, Wang, Qi-Wei, Jin, You-Peng
• Format: Journal Article
• Language: English
• Published: China World Journal of Emergency Medicine 2022; Department of Pediatric Intensive Care Unit,Shandong Provincial Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250021,China; Department of Pediatric Intensive Care Unit,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China%Department of Pediatrics,Affiliated Hospital of Jining Medical University,Jining 272129,China%Department of Pediatrics,Qingdao Women and Children Hospital,Qingdao 266034,China%Department of Pediatric Intensive Care Unit,Shandong Provincial Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250021,China%Department of Pediatric Intensive Care Unit,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China; Second Affiliated Hospital of Zhejiang University School of Medicine
• Subjects: Health aspects; Hospital patients; Infection; Medical research; Medicine, Experimental; Mortality; Original; Pediatrics; Prognosis; Risk factors; Infection; SIRS; Children; pSOFA; Mortality; Simple-pSOFA
• ISSN: 1920-8642
• DOI: 10.5847/wjem.j.1920-8642.2022.060

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. KEYWORDS: Simple-pSOFA; pSOFA; Children; Mortality; Infection; SIRS