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. 2018 Feb;44(2):179-188.
doi: 10.1007/s00134-017-5021-8. Epub 2017 Dec 19.

Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit

Luregn J Schlapbach  1   2   3   4 , Lahn Straney  5 , Rinaldo Bellomo  6   7 , Graeme MacLaren  6   8   9 , David Pilcher  10   11   12
Affiliations

Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit

Luregn J Schlapbach et al. Intensive Care Med. 2018 Feb.

Abstract

Purpose: The Sepsis-3 consensus task force defined sepsis as life-threatening organ dysfunction caused by dysregulated host response to infection. However, the clinical criteria for this definition were neither designed for nor validated in children. We validated the performance of SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores as predictors of outcome in children.

Methods: We performed a multicentre binational cohort study of patients < 18 years admitted with infection to ICUs in Australia and New Zealand. The primary outcome was ICU mortality. SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores were compared using crude and adjusted area under the receiver operating characteristic curve (AUROC) analysis.

Results: Of 2594 paediatric ICU admissions due to infection, 151 (5.8%) children died, and 949/2594 (36.6%) patients died or experienced an ICU length of stay ≥ 3 days. A ≥ 2-point increase in the individual score was associated with a crude mortality increase from 3.1 to 6.8% for SIRS, from 1.9 to 7.6% for age-adapted SOFA, from 1.7 to 7.3% for PELOD-2, and from 3.9 to 8.1% for qSOFA (p < 0.001). The discrimination of outcomes was significantly higher for SOFA (adjusted AUROC 0.829; 0.791-0.868) and PELOD-2 (0.816; 0.777-0.854) than for qSOFA (0.739; 0.695-0.784) and SIRS (0.710; 0.664-0.756).

Conclusions: SIRS criteria lack specificity to identify children with infection at substantially higher risk of mortality. We demonstrate that adapting Sepsis-3 to age-specific criteria performs better than Sepsis-2-based criteria. Our findings support the translation of Sepsis-3 into paediatric-specific sepsis definitions and highlight the importance of robust paediatric organ dysfunction characterization.

Keywords: Childhood; Critical care; Infection; Mortality; PELOD; SIRS; SOFA; Scores; Sepsis.

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Conflict of interest statement

None of the authors have declared a conflict of interest.

Figures

Fig. 1
Fig. 1
Distribution of patients < 18 years with infection by SIRS criteria, PELOD-2 score, SOFA and qSOFA score measured during the first 24 h of ICU admission
Fig. 2
Fig. 2
Mortality by SIRS criteria, PELOD-2 score, SOFA and qSOFA score measured during the first 24 h of ICU admission in patients < 18 years admitted with infection
Fig. 3
Fig. 3
Comparison of area under the receiver operating characteristic curves (AUROCS) to discriminate in-hospital mortality (primary outcome) and in-hospital mortality or ICU length of stay of 3 days or more (secondary outcome) for SIRS criteria, SOFA, qSOFA, and PELOD scores at ICU admission. AUROCs are shown for primary (a, c) and secondary (b, d) outcomes using crude (a, b) and adjusted (c, d) models
See this image and copyright information in PMC

Comment in

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