Evaluation of pediatric sequential organ failure assessment score in diagnosis and prognosis of children with infection in pediatric intensive care unit / 中国小儿急救医学

ABSTRACT

Objective:To evaluate the predictive value of the pediatric sequential organ failure assessment (pSOFA) in predicting the prognosis of infected children.Methods:We performed a retrospective analysis of children with infection or suspected infection who were hospitalized at PICU from January 1, 2018 to December 31, 2018.The worst physiological and laboratory indicators detected within 24 hours after admission were collected.The pSOFA and systemic inflammatory reaction syndrome(SIRS) score were used for diagnosis.Patients with pSOFA≥2 and SIRS score≥2 were included.Pediatric multiple organ dysfunction score(P-MODS), pediatric logistic organ dysfunction(PELOD-2), and pediatric critical illness score were performed for those patients who met the criteria.Survival or death during hospitalization was used to determine the prognosis, and death conditions with different scores of pSOFA and SIRS were analyzed.Receiver operation characteristic curve was used to evaluate the predictive value of pSOFA for the prognosis of children with infection.Results:A total of 755 cases were eligible for infection or suspected infection, among which 303 children were eligible for SIRS and pSOFA score ≥2, 165 cases were eligible for SIRS score ≥2 alone, 85 cases were eligible for pSOFA score ≥2 alone, and 53 cases were eligible for both.The in-hospital fatality rates of pSOFA 2, 3, 4, 5-6 and 7-9 points were 8.97%, 15.38%, 26.09%, 57.64% and 100%, respectively.With the increase of pSOFA, the fatality rate increased gradually.The in-hospital fatality rates of SIRS score 2, 3 and 4 were 3.64%, 12.64% and 4.76%, respectively.The area under the receiver operating characteristic curve of pSOFA was 0.74 (95% CI 0.62, 0.86), which was significantly higher than the other four scores.At a cut-off value of 4 points, it had a sensitivity of 56% and a specificity of 82% to predict prognosis. Conclusion:The pSOFA score has the highest accuracy than the SIRS score, P-MODS, PELOD-2 score and pediatric critical illness score in predicting the hospital mortality of PICU-infected children.