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

Luregn J. Schlapbach, Lahn Straney, Rinaldo Bellomo, Graeme MacLaren, David Pilcher

Research output: Contribution to journalArticleResearchpeer-review

29 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)179-188
Number of pages10
JournalIntensive Care Medicine
Volume44
Issue number2
DOIs
Publication statusPublished - Feb 2018

Keywords

  • Childhood
  • Critical care
  • Infection
  • Mortality
  • PELOD
  • Scores
  • Sepsis
  • SIRS
  • SOFA

Cite this

@article{b0b0d77684ac42ce8ef979c919294e88,
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",
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.",
keywords = "Childhood, Critical care, Infection, Mortality, PELOD, Scores, Sepsis, SIRS, SOFA",
author = "Schlapbach, {Luregn J.} and Lahn Straney and Rinaldo Bellomo and Graeme MacLaren and David Pilcher",
year = "2018",
month = "2",
doi = "10.1007/s00134-017-5021-8",
language = "English",
volume = "44",
pages = "179--188",
journal = "Intensive Care Medicine",
issn = "0342-4642",
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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. / Schlapbach, Luregn J.; Straney, Lahn; Bellomo, Rinaldo; MacLaren, Graeme; Pilcher, David.

In: Intensive Care Medicine, Vol. 44, No. 2, 02.2018, p. 179-188.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - 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

AU - Schlapbach, Luregn J.

AU - Straney, Lahn

AU - Bellomo, Rinaldo

AU - MacLaren, Graeme

AU - Pilcher, David

PY - 2018/2

Y1 - 2018/2

N2 - 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.

AB - 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.

KW - Childhood

KW - Critical care

KW - Infection

KW - Mortality

KW - PELOD

KW - Scores

KW - Sepsis

KW - SIRS

KW - SOFA

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U2 - 10.1007/s00134-017-5021-8

DO - 10.1007/s00134-017-5021-8

M3 - Article

VL - 44

SP - 179

EP - 188

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 2

ER -