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Title: 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
Austin Authors: Schlapbach, Luregn J;Straney, Lahn;Bellomo, Rinaldo ;MacLaren, Graeme;Pilcher, David
Affiliation: Faculty of Medicine, The University of Queensland, Brisbane, Australia
Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, Australia
Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Australia
Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
University of Melbourne, Melbourne, Australia
Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore
Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), ANZICS House, Levers Terrace, Carlton South, Melbourne, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Department of Intensive Care, The Alfred Hospital, Commercial Road, Prahran, Victoria, Australia
Issue Date: Feb-2018
Date: 2017-12-19
Publication information: Intensive Care Medicine 2017; 44(2): 179-188
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.
DOI: 10.1007/s00134-017-5021-8
ORCID: 0000-0002-1650-8939
Journal: Intensive Care Medicine
PubMed URL:
Type: Journal Article
Subjects: Childhood
Critical care
Type of Clinical Study or Trial: Cohort Study
Appears in Collections:Journal articles

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