Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 17:12:1463986.
doi: 10.3389/fped.2024.1463986. eCollection 2024.

Clinical prognostic models in children with sepsis in low- and middle-income countries: a systematic review and meta-analysis

Jessica Jordan #  1 , Celinie M Nguyen #  1 , Lauren M Fletcher  2 , Stephanie C Garbern  3
Affiliations

Clinical prognostic models in children with sepsis in low- and middle-income countries: a systematic review and meta-analysis

Jessica Jordan et al. Front Pediatr. .

Abstract

Introduction: Sepsis is the leading cause of child death worldwide, with the majority of these deaths occurring in low- and middle-income countries (LMICs). The aim of this systematic review and meta-analysis was to describe clinical prognostic scores and models for pediatric sepsis outcomes and assess the performance of these scores for predicting mortality in LMICs.

Methods: Ovid Medline, CINAHL, Cochrane Library, EBSCO Global Health, and Web of Science, were searched through September 2022 for citations related to the development or validation of a clinical prognostic score or model among children with sepsis, conducted in LMIC. Titles, abstracts, and full texts were screened by two independent reviewers and data extracted included population characteristics, variables included, outcomes, and model performance. Risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST).

Results: 4,251 titles/abstracts and 315 full-text studies were screened, with 12 studies meeting inclusion criteria. Study countries included India, China, Egypt, Indonesia, Tanzania, and a multi-site study in Latin America. Prognostic scores/models included existing scores such as PELOD-2, pSOFA, PRISM, P-MODS, refractory shock criteria. There was high risk of bias in all studies. Meta-analysis was possible for pSOFA, PELOD-2, PRISM, and P-MODS, with pooled area under the receiver-operator characteristic curve of 0.86 (95%CI 0.78-0.94), 0.83 (95% CI 0.76-0.91), respectively.

Conclusion: Relatively few clinical scores and models have been externally validated for prognostication and risk-stratification among children with sepsis in diverse LMIC settings. Notably there were no studies from low-income countries. Some potentially relevant studies were excluded due to lack of clarity regarding the presence of sepsis in the study populations. More widespread and standardized use of sepsis criteria may aid in better understanding the burden of sepsis and prognostic model performance at the bedside among children in LMICs. Further research to externally validate, implement and adapt these models is needed to account for challenges in use of these scores in resource-limited settings.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340126, PROSPERO [CRD42022340126].

Keywords: emergency medicine; global health; low-and middle-income countries; pediatrics; prognostic model; sepsis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Forest plot for pSOFA AUC.
Figure 3
Figure 3
Forest plot for PELOD-2 AUC.
Figure 4
Figure 4
Summary risk of bias assessment using PROBAST.
Figure 5
Figure 5
Summary of applicability assessment using PROBAST.
See this image and copyright information in PMC

References

    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. (2016) 315(8):801–10. 10.1001/jama.2016.0287 - DOI - PMC - PubMed
    1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of disease study. Lancet Lond Engl. (2020) 395(10219):200–11. 10.1016/S0140-6736(19)32989-7 - DOI - PMC - PubMed
    1. Reiner RC Jr, Olsen HE, Ikeda CT, Echko MM, Ballestreros KE, Manguerra H, et al. GBD 2017 Child and Adolescent Health Collaborators, Reiner RC, Olsen HE, Ikeda CT, Echko MM, Ballestreros KE, et al. Diseases, injuries, and risk factors in child and adolescent health, 1990 to 2017: findings from the global burden of diseases, injuries, and risk factors 2017 study. JAMA Pediatr. (2019) 173(6):e190337. 10.1001/jamapediatrics.2019.0337 - DOI - PMC - PubMed
    1. Rudd KE, Kissoon N, Limmathurotsakul D, Bory S, Mutahunga B, Seymour CW, et al. The global burden of sepsis: barriers and potential solutions. Crit Care. (2018) 22(1):232. 10.1186/s13054-018-2157-z - DOI - PMC - PubMed
    1. Goldstein B, Giroir B, Randolph A, International consensus conference on pediatric sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. (2005) 6(1):2–8. 10.1097/01.PCC.0000149131.72248.E6 - DOI - PubMed

Publication types

LinkOut - more resources