Application of New Pediatric Sepsis Definition to a Multicenter Observational Cohort of Previously Enrolled Severe Sepsis Patients Defined by SIRS Plus Organ Dysfunction

Abstract

IntroductionIn 2024, a Society of Critical Care Medicine task force updated the pediatric sepsis definition from the presence of suspected or confirmed infection, and a systemic inflammatory response (SIRS) with organ dysfunction, to a novel definition. Our objective is to identify how many patients previously identified as having severe sepsis would continue to meet the new definition.Materials and methodsWe performed a secondary analysis of the Phenotyping Sepsis-Induced Multiple Organ Failure cohort of 401 children with suspected or confirmed infection, two of four SIRS criteria and organ dysfunction enrolled between 2015-2017. We calculated a modified Phoenix Sepsis Criteria Score (mPSC) for participants and compared those with mPSC of greater than or equal to 2 or less than 2 according to the 2024 definition.ResultsOf 401 children, 132 (33%) did not meet mPSC definitions. While children meeting mPSC had more organ dysfunction, the total mortality did not differ. One in 4 children requiring extracorporeal membrane oxygenation and 1 in 4 mortalities did not meet the mPSC definition. In logistic regression models, in the complete cohort, hematologic (OR 4.4, 95% CI: 1.8-10.2, P-value = .001), central nervous system (OR 2.3, 95% CI: 1.0-5.1, P-value = .046) and renal failure (OR: 3.2, 95% CI:1.2-7.9, P-value = .017) predicted mortality; in the mPSC subgroup pulmonary (OR: 3.6, 95% CI:1.3-13.3, P-value = .030) and hematologic failure (OR 5.6, 95% CI: 2.2-14.5, P-value = .0003) were significant predictors. In the mPSC excluded subgroup, only renal failure predicted mortality (OR 9.6, 95% CI 1.1-73.0, P-value = .028).ConclusionsFurther study of the impact of the 2024 data-driven organ dysfunction definition on pediatric sepsis research, patient safety, and clinical benchmarking efforts is warranted.

Keywords: infection; mortality; organ failure; pediatric sepsis; phoenix sepsis criteria; sepsis definitions.

Figure 1.

Venn diagram of 1A) mortality and 1B) ECMO cannulation in the complete PHENOMS cohort as classified by modified Phoenix sepsis criteria.