Clinical Ability Of Age-Stratified Critical Care Scoring Systems In Predicting The Prognosis Of Children With Infection Admitted To The Pediatric Intensive Care Unit

Objective: To analyze the performances of Inflammatory response syndrome(SIRS),Pediatric-Sequential organ failure assessment(p-SOFA),Quick-Sequential organ failure assessment(q-SOFA)and Pediatric logistic organ dysfunction 2(PELOD2)after age stratification as predictors of outcome in children who with infection in PICU.Find out whether the diagnostic criteria for infection with organ dysfunction in the definition of Sepsis 3.0 was more suitable for children than the definition of the 2005 version,which can strengthen the early identification of the patient condition and improving prognosis.Methods: Children with suspected or confirmed infection admitted to PICU of Hunan Children's hospital from July 2017 to July 2018 were included.Collecting clinical data and laboratory test results of patient within 24 hours of admission and measure SIRS standards,p-SOFA,qSOFA,and PELOD2 scores for different age groups.Regarding the death of the child as the primary adverse outcome,the adverse secondary outcome was defined as hospital stay extended,and the receiver operating characteristic curve(ROC)was used to evaluate the predictive value of the four scoring systems.Results: 1.A total of 353 children with infection in PICU were enrolled in this study,including 215 males(60.9%)and 138 females(39.1%).The median age was 13(4,36)months,41(11.6%)of them died on the 28 th day in PICU,and 312(88.4%)survived,median hospital stay was 13 days,and median ICU stay was 8 days.The low respiratory tract was the main site of the initial infection,followed by the nervous system.The proportion of children in the death group who used invasive respiratory support,vasoactive drugs,and blood purification treatment was higher than that in the survival group.Among the indicators for assessing the severity of the disease,77 children were diagnosed with severe sepsis and 25 of them died(32.5%),which was significantly higher risk of death than children with non-severe sepsis.And the SIRS criteria,p-SOFA score,q-SOFA score,and PELOD2 score for children were higher in the death group than those in the survival group,and the differences were statistically significant(P <0.05).2.Mortality in all four assessment systems increased with increasing scores.When each score was ?2 points and 2 or more criteria are met,the risk of death was significantly increased;and in p-SOFA and PELOD2,patients with a score of 2 or more were hospitalized longer than those who were not satisfied,but when PELOD ? 8 points,the length of hospitalization and ICU hospitalization was significantly shortened,and the difference was notably(P <0.05).3.The age-adapted SIRS standard,p-SOFA,q-SOFA,and PELOD2 scores predict the AUC for death in children with infection in PICU on day 28 were 0.622,0.923,0.644,and 0.871,respectively.Suggesting that pSOFA has the best predictive value for death,followed by PELOD2,and the value of q-SOFA and SIRS standards is relatively low.After stratified according to whether it meets 2 criteria or 2 points,it can be seen that the predictive sensitivity and specificity of p-SOFA ? 2 points for death were 100% and 47.8%,respectively,and the sensitivity and specificity of PELOD2 ? 2 points were 92.7% and 60.9%,respectively.While the AUC of severe sepsis predicted death was 0.722,the sensitivity was 61%,and the specificity was 83.3%.Compared with the prediction efficacy of pSOFA score,the difference was statistically significant(Z=4.231,P<0.001).A total of 242 children(68.6%)who reached the secondary outcome for death or PICU ?7 days,of which the p-SOFA score and PELOD2 score had low predictive value,with AUCs of 0.691 and 0.686,respectively,while the values of q-SOFA score and the SIRS standard were much lower.Conclusion: 1.There were some differences in the prediction of poor prognosis among children with infection in PICU in the age-adjusted SIRS standard,p-SOFA score,q-SOFA score and PELOD2 score,among which the value of prediction in p-SOFA score was the highest,followed by PELOD2.2.SOFA,the assessment tool in the definition of sepsis 3.0,predicts the severity and prognosis of sepsis in children after age stratification better than the SIRS standard,thereby provide evidence for updating the definition of childhood sepsis based on sepsis 3.0.