Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study.

Previous studies applying Sepsis-3 criteria to children were based on retrospective analyses of PICU cohorts. We aimed to compare organ dysfunction criteria in children with blood culture-proven sepsis, including emergency department, PICU, and ward patients, and to assess relevance of organ dysfunctions for mortality prediction. We have carried out a nonprespecified, secondary analysis of a prospective dataset collected from September 2011 to December 2015. Emergency departments, wards, and PICUs in 10 tertiary children's hospitals in Switzerland. Children younger than 17 years old with blood culture-proven sepsis. We excluded preterm infants and term infants younger than 7 days old. None. We compared the 2005 International Pediatric Sepsis Consensus Conference (IPSCC), Pediatric Logistic Organ Dysfunction-2 (PELOD-2), pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Organ Dysfunction Information Update Mandate (PODIUM) scores, measured at blood culture sampling, to predict 30-day mortality. We analyzed 877 sepsis episodes in 807 children, with a 30-day mortality of 4.3%. Percentage with organ dysfunction ranged from 32.7% (IPSCC) to 55.3% (pSOFA). In adjusted analyses, the accuracy for identification of 30-day mortality was area under the curve (AUC) 0.87 (95% CI, 0.82-0.92) for IPSCC, 0.83 (0.76-0.89) for PELOD-2, 0.85 (0.78-0.92) for pSOFA, and 0.85 (0.78-0.91) for PODIUM. When restricting scores to neurologic, respiratory, and cardiovascular dysfunction, the adjusted AUC was 0.89 (0.84-0.94) for IPSCC, 0.85 (0.79-0.91) for PELOD-2, 0.87 (0.81-0.93) for pSOFA, and 0.88 (0.83-0.93) for PODIUM. IPSCC, PELOD-2, pSOFA, and PODIUM performed similarly to predict 30-day mortality. Simplified scores restricted to neurologic, respiratory, and cardiovascular dysfunction yielded comparable performance.

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Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Déclaration de conflit d'intérêts

Dr. Heininger received funding from Global Pertussis Initiative and the Central and Eastern Europe Pertussis Awareness Group, Infectopharm, Merck, Moderna, Pfizer, Roche, Sanofi, and Sanofi Pasteur; he disclosed that he is on the Data Monitoring Committee, the phase II study of adjuvanted pandemic influenza vaccine, the Data Monitoring Committee Norovirus Bivalent Virus-like particle Vaccine Program, the Meta Data Safety Monitoring Board for Coalition for Epidemic Preparedness Innovations, the Data Monitoring Committee, the cell culture influenza vaccine, and the Varicella Advisory Board. Dr. Riedel’s institution received funding from Sentec AG. Dr. Agyeman’s institution received funding from the Swiss National Science Foundation (342730_153158/1 and 320030_201060/1), the Swiss Society of Intensive Care, the Bangerter Foundation, the Vinetum and Borer Foundation, the Foundation for the Health of Children and Adolescents, and the Sanofi-Aventis Suisse; he received support for article research from the Swiss National Science Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.