Comparison of the Pediatric Sequential Organ Failure Assessment (p SOFA) Score and Lactate Clearance as Predictors of Morbidity and Mortality in Pediatric Sepsis: A Prospective Observational Study

Abstract

Background: Sepsis continues to be a leading cause of illness and mortality in children around the world. Various scoring systems have been devised to predict the outcome of pediatric sepsis. Pediatric sequential organ failure assessment (p SOFA) and lactate clearance are the two commonly used methods.

Objective: The aim of this study was to compare the p SOFA score with lactate clearance as predictors of morbidity and mortality in pediatric sepsis, to compare the initial plasma lactate level and lactate clearance, and to know which is better to predict outcomes in sepsis and septic shock.

Methods: This prospective observational study was conducted in a pediatric intensive care unit of a tertiary care teaching hospital from July 2022 to June 2024. The blood lactate level and p SOFA score were assessed at admission and at 24 and 48 hours, and lactate clearance was calculated at 24 and 48 hours of admission. The receiver operating characteristic (ROC) curve was plotted to predict deaths using p SOFA, lactate level, and lactate clearance.

Results: A total of 71 children were enrolled in the study. All children were divided into two groups, 58 (82%) survivors and 13 (18%) non-survivors. The most common diagnosis was pneumonia, observed in 31 (43.6%) children. Compared to survivors, non-survivors had a higher prevalence of multiple organ dysfunction syndrome (MODS). The most common organ system involved was the cardiovascular, in 50 (70%) cases. For predicting mortality, p SOFA scores were statistically significant at admission and at 24 and 48 hours with a high area under the curve (AUC) at 48 hours (0.985). Lactate clearance at 24 hours was a better predictor of mortality than at 48 hours with a higher AUC (0.958).

Conclusion: Both p SOFA score at 48 hours and lactate clearance at 24 hours were significant predictors of mortality. Among both parameters, lactate clearance at 24 hours was superior in predicting mortality early.

Keywords: lactate clearance; mortality; p sofa; pediatric sepsis; picu; septic shock.

Figure 1. ROC curve of p SOFA at admission and at 24 and 48 hours

ROC: receiver operating characteristic; p SOFA (0): ROC curve of pediatric sequential organ failure assessment at admission; p SOFA (1): ROC curve of pediatric sequential organ failure assessment at 24 hours of admission; p SOFA (2): ROC curve of pediatric sequential organ failure assessment at 48 hours of admission

Figure 2. ROC curve of lactate at admission and at 24 and 48 hours

ROC: receiver operating characteristic; LACT (0): ROC curve of lactate at admission; LACT (1): ROC curve of lactate at 24 hours of admission; LACT (2): ROC curve of lactate at 48 hours of admission

Figure 3. ROC curve of lactate clearance

ROC: receiver operating characteristic; Lactate Clearance_0 to 24: ROC curve of lactate clearance from admission to 24 hours; Lactate Clearance_0 to 48: ROC curve of lactate clearance from admission to 48 hours